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

Updated: Aug 30, 2019
  • Author: Marina Jovanovic, MD, PhD; Chief Editor: William D James, MD  more...
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Answer

The suggested dosage and duration of treatment with isotretinoin is similar to those proposed for severe forms of acne vulgaris (0.5-1.2 mg/kg/day for 4-12 months). However, the presence of acne vulgaris or of a history of previous acne had no impact on outcome. An absence or reduced volumes of the sebaceous glands are observed in hidradenitis suppurativa. Its usage in hidradenitis suppurativa is often disappointing; patients were assessed as nonresponders in 64.4%, the observed response (evaluated as moderate to significant) among the rest of the patients was mainly restricted to those with mild hidradenitis suppurativa forms (Hurley I). In general, the literature data are inconsistent, but it is currently recommended not to use isotretinoin in the treatment of hidradenitis suppurativa. [1]

Caution should be taken if liver enzyme or serum lipid levels increase during therapy; it should avoided/stopped if these values increase three and two times over the upper normal range limit, respectively. Since both retinoids and tetracyclines can increase intracranial pressure, their combined use is also contraindicated.


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