Long-term results of acitretin therapy for hidradenitis suppurativa. Is acne inversa also a misnomer?

BACKGROUND: Hidradenitis suppurativa (HS) is a distressing chronic inflammatory skin disorder which affects predominantly the groins and axillae. In analogy to acne, oral isotretinoin has been considered in the treatment of HS, although there are strong indications that this drug has only a very limited therapeutic effect. During the past 25 years scattered case reports have described promising results of treatment with acitretin.

OBJECTIVES: To evaluate the long-term efficacy of acitretin monotherapy.

METHODS: A retrospective study in 12 patients with severe, recalcitrant HS who were treated with acitretin for 9-12 months at one Dermatology Centre in the Netherlands between 2005 and 2007 and were followed up to 4 years. The patients were men and infertile women. The efficacy of the treatment was rated by the patients on global maximum pain of nodules and abscesses on a visual analogue scale (VAS) as well as by physician global assessment.

RESULTS: All 12 patients achieved remission and experienced a significant decrease in pain as assessed by VAS. In nine patients long-lasting improvement was observed, with no recurrence of lesions after 6 months (n = 1), 1 year (n = 3), >2 years (n = 2), >3 years (n = 2) and >4 years (n = 1).

CONCLUSIONS: Acitretin appears to be an effective treatment for refractory HS, leading to reduction of pain from painful nodules and reducing the extent of the disease for a prolonged period.