FDA Boxed Warnings: Should Package Inserts Include Levels of Evidence?

Many medications commonly used in dermatology come with package inserts that contain boxed warnings that are frequently not evidence-based. Boxed warnings are the most serious warnings that the US Food and Drug Administration (FDA) can issue for medications through various methods, like class labeling, despite the absence of factual, high-quality evidence. Currently, there are several medications labeled with these boxed warnings for which there is no evidence, and in many cases, there actually may exist refuting evidence. However, these warnings persist in the package inserts. This has led to much hesitancy in their use, contributing to the undertreatment, or even lack of treatment, of conditions for which these medications are efficacious. Furthermore, the negative physical and mental effects of the lack of effective treatment for patients with skin disorders are well-documented. The authors call for transparency regarding the evidence, or lack thereof, behind these boxed warnings on the part of the FDA.