Hidradenitis suppurativa

A retrospective study of 25 patients indicates that oral isotretinoin is a potential treatment for selected individuals living with hidradenitis suppurativa.

Hidradenitis Suppurativa (also known as acne inversa or Vernuiel’s Disease) is a chronic skin condition characterized by recurrent painful lumps under the skin.  Found in the intertriginous regions (body folds or where skin rubs together) like the armpit and groin areas, these bumps are infections that result from blockages in the hair follicles. While most spontaneously resolve, some may rupture, resulting in a foul-smelling, purulent discharge. Recurrent episodes can lead to the development of scarring and fibrous tunnels that connect these ruptured areas, which can complicate wound healing and treatment.

The exact reasons why some people develop Hidradenitis Suppurativa (HA) and others do not remain a mystery; what is known is that females from puberty to the age of 40 are most commonly afflicted. Excess weight, stress, hormonal changes and hygiene are considered risk factors.

The repeating cycle of infection and drainage can be potentially debilitating, both physically and socially. Numerous treatment options are available, depending on the severity of symptoms. Lifestyle changes like weight loss and stress reduction are usually coupled with pharmaceutical treatments; in extreme cases, surgical removal of these areas of infection is an option.

Isotretinoin has long been used for the treatment of severe acne; by decreasing the amount of oil (sebum) produced by skin glands it can arrest the development and progression of acne that has not responded to topical interventions like antibiotics or benzoyl peroxide. Physicians have also been using oral isotretinoin for HA, it is hoped that its oil-regulating mechanism can also prevent the symptoms of blockage and infection—but reports of its efficacy remain controversial at best.

The online journal Dermatology recently published a retrospective study of patients indicating the potential benefits of isotretinoin for HA. From 2014-2016, 25 out of 79 HA patients were selected to undergo oral isotretinoin therapy, and as they were followed up through the course of their condition it was noted that 17 of these patients had significant clinical improvement. The study concludes that for specific patients with HA (younger age group, less weight, better hygiene standards) isotretinoin can be a beneficial mode of therapy.

While the results look promising, there are caveats to this study: results for a low, preselected patient number of 25 must be validated in larger population groups.  Moreover, isotretinoin is notorious for its side effects and possibly causing birth defects; these considerations must be weighed in further studies exploring the potential benefits of adding isotretinoin in the challenging management of Hidradenitis Suppurativa.

 

Written by Jay Martin, M.D.

Reference:

Huang, C.M , and Kirchhof, M.G. .”A New Perspective on Isotretinoin Treatment of Hidradenitis Suppurativa:  A Retrospective Chart Review of Patient Outcomes”. Dermatology 2017:  DOI: 10.1159/0000477207.

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