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Treatment – Retinoids

By Editorial Team · October 23, 2020

Although hidradenitis suppurativa (HS) has no cure, treatment with medicines like retinoids can relieve the symptoms.1

HS is a chronic, painful inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. In sporadic flares, bumps worsen and return again and again. This leads to symptoms like abscesses, inflammation, and scars on the skin. Retinoids that are commonly used to treat acne and inflammatory skin conditions can be effective in treating the symptoms of HS.2-4

How do retinoids work?

Retinoids are a type of medicines that are related to vitamin A. In general, they help control how quickly skin cells grow and shed. They also help regulate the immune system and are anti-inflammatory.5

What kinds are used for HS?

Doctors commonly prescribe retinoids for the treatment of HS. Studies have looked at the use of 3 different retinoids in people with HS. These drugs are systemic retinoids, which means they are drugs that have an effect on the entire body and not just HS symptoms. They include:4-9

  • Acitretin (Soriatane)
  • Isotretinoin (Absorica, Accutane, Zenatane, Myorisan)
  • Alitretinoin (Panretin)

Acitretin (Soriatane) for HS treatment

Studies of acitretin have shown notable improvement in about 60 percent of people with mild to moderate HS. In more severe HS, it is effective as an addition to other medications that affect the whole body.7

Acitretin reduces overproduction of keratin, which is involved in blocking hair follicles and causing HS bumps. Keratin is a tough protein that makes up the outer layer of skin, hair, and nails.6-8

Acitretin works for HS that has not responded to other treatments. It decreases inflammation, calms the immune system, and reduces pain and other symptoms.9

Isotretinoin (Absorica, Zenatane, Myorisan) for HS treatment

There is not much promising research on the effects of isotretinoin for HS. One study found that fewer than 50 percent of people with HS showed improvement, mostly those with milder disease. More than 10 percent of responders relapsed within a few months after stopping treatment.4,6

The limited positive effects of isotretinoin are due to its reduction of inflammation, researchers think. Its main effect, however, is reduction of sebaceous gland activity, which is not involved in HS. Sebaceous glands secrete an oil that protects the hair and skin.6

If isotretinoin is used in HS treatment, it should be used only if other treatments fail.4

Alitretinoin (Panretin) for HS treatment

There is limited information about the use of alitretinoin for HS. In a small study, use of alitretinoin showed improvement in all study participants. It is available in Canada and other countries, but not in the United States. More research is needed to understand its use and effectiveness in HS.4

What are the possible side effects?

Side effects of retinoids vary depending on the drug and its dosage. Not everyone experiences the same side effects, and different people may experience varying levels of severity.

Some of the common side effects of certain retinoids include:6,10,11

  • Extremely dry skin and inflammation of the lips
  • Reduced night vision
  • High cholesterol and triglycerides
  • Headache
  • Joint and muscle pain
  • Fatigue
  • Abnormal bone growth
  • Inflammation of the bowel, pancreas, and liver

Retinoids have also been linked to depression.11

These are not all the possible side effects of retinoids. Talk to your doctor about what to expect or if you experience any changes that worry you.

Things to know

Retinoids should not be taken by women who are pregnant because severe birth defects are a concern. Women of childbearing age must use birth control while taking acitretin and for 3 years after stopping because of the drug’s extreme risk of severe birth defects. Talk to your doctor if you are pregnant, plan to become pregnant, or if you are breastfeeding.10,11

Acitretin can badly interact with certain other types of drugs, including other retinoids. Before taking any retinoids, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.6-9

Retinoids are just 1 part of HS treatment. You should discuss the risks and benefits of these drugs with your doctors, as well as any other steps you should take to avoid side effects. Other approaches may include different drugs, surgery, diet and lifestyle changes, and alternative medicine.

Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. Hidradenitis suppurativa (HS). National Health System. Available at https://www.nhs.uk/conditions/hidradenitis-suppurativa/. Accessed 7/24/2020.
  2. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  3. Jemec GBE. Clinical practice: Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi:10.1056/NEJMcp1014163.
  4. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91‐101.
  5. Oral retinoids. DermNet NZ. Available at https://dermnetnz.org/topics/oral-retinoids/. Accessed 10/2/2020.
  6. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015 Jan;29(4):619-644. doi:10.1111/jdv.12966.
  7. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105‐115. doi:10.2147/CCID.S111019.eCollection 2017.
  8. Keratin. Dermatology glossary of terms. DermNet NZ. Available at https://www.dermnetnz.org/glossary/. Accessed 7/17/2020.
  9. Nazary M, van der Zee H, Prens E, et al., Pathogenesis and pharmacotherapy of hidradenitis suppurativa. Eur J Pharmacol. 2011 Dec 15;672(1-3):1-8. doi:10.1016/j.ejphar.2011.08.047.
  10. Blok JL, van Hattem S, Jonkman MF, Horváth B. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. British Journal of Dermatology. 2013; 168:243-252. doi:10.1111/bjd.12104.
  11. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: supplemental materials. Hidradenitis Suppurativa Foundation Inc. 2019. Available at https://www.hs-foundation.org/guidelines/. Accessed 6/24/2020.

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