What is the role of retinoids in the treatment of hidradenitis suppurativa (HS)?

Updated: Nov 20, 2020
  • Author: Marina Jovanovic, MD, PhD; Chief Editor: William D James, MD  more...
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Some patients have dramatic responses to isotretinoin 1 mg/kg/day as monotherapy. [67] Retinoids may also be useful only as an adjunct to reduce inflammation before and after surgery. [52, 88]

Results from a long-term follow-up study indicate that although the response of hidradenitis suppurativa to isotretinoin is only moderate and is related to the severity of the disease, the promising effects of acitretin therapy described in this case series suggests the need for a randomized, controlled trial. [105, 106] The dose of isotretinoin has not been found to be important in treating hidradenitis suppurativa. Isotretinoin does not affect the size of the apocrine gland, and etretinate or acitretin (25 mg bid) may be more useful, at least in some cases. The fact that some conditions do not respond to isotretinoin, yet do respond to etretinate and acitretin, suggests that the suppression of hyperkeratinization is more important than glandular shrinkage. In parous women, a prolonged course of isotretinoin is probably a safer initial choice; however, severe complications, such as acute pancreatitis associated with hyperlipidemia, may occur, even in patients without an identifiable risk factor. [107] In general, the results from the use of oral retinoids are disappointing. [2]

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