Could isotretinoin flare hidradenitis suppurativa? A case series

Abstract

Summary We report eight cases of patients with severe acne who were treated with isotretinoin and developed painful nodules in the axillae and groin, consistent with hidradenitis suppurativa (HS). The pathogenesis of HS is still not completely understood; recent research from a study in 2011 of biopsies from HS lesions showed a reduction or absence of sebaceous glands compared with normal skin in patients with HS, with the report suggesting that this contributes to the pathogenesis of the disease. Interestingly, the main effect of isotretinoin is to decrease the size and action of sebaceous glands, so hypothetically, as isotretinoin acts by reducing the sebaceous glands further it could potentially aggravate HS. Our experience has instilled caution in our prescribing of isotretinoin, and we question patients, particularly those with acne conglobata, about symptoms of HS prior to and during treatment.

Isotretinoin and hidradenitis suppurativa

“…Collectively, our six patients showed a clear tendency for their disease to deteriorate, or at best, remain unchanged, when regarding change in the total HS inflammatory nodule count; following isotretinoin treatment, three patients had a larger number of inflammatory HS nodules after treatment (an increase of five, three and three nodules, respectively), while two patients had the same number of nodules and one patient experienced a reduction in nodule count of only one nodule. These results underline the observations by Gallagher et al . of development of new inflammatory HS nodules in patients treated with isotretinoin.…”

“…In conclusion, this important study by Gallagher et al ., in conjunction with our data from a tertiary HS centre, supports the pathogenic assumption that the sebaceous glands and associated commensal bacteria may play a role in the pathogenesis of HS and that systemic isotretinoin may initiate flares of HS or exacerbate pre‐existing HS. Nevertheless, isotretinoin may be considered in patients with HS with concomitant severe AV as the main skin manifestation but not as sole therapy for HS.…”

“…We read with great interest the recent article by Gallagher et al . in Clinical and Experimental Dermatology , in which eight patients with severe acne vulgaris (AV) who were treated with isotretinoin developed painful nodules in their axillae and groins, consistent with hidradenitis suppurativa (HS).…”

Low dose of isotretinoin: A comprehensive review

“…On the other hand, a flare‐up or development of HS lesions was noted in four out of eight young, thin male patients at the 10th weeks of low‐dose isotretinoin therapy (20 mg/day), despite improvement of facial lesions, and four were improved on isotretinoin cessation (Gallagher, Kirthi, Cotter, Revuz, & Tobin, ). That flare‐up may be due to initial increase of HS breakouts (Caposiena Caro & Bianchi, ).…”

Can retinoids flare hidradenitis suppurativa? A further case series

“…We read with great interest the recent article by Gallagher et al . in Clinical and Experimental Dermatology , concerning eight patients with severe acne who were treated with isotretinoin and developed hidradenitis suppurativa (HS).…”