Clinical Experience

17.2.2.1 Isotretinoin Monotherapy for HS

Isotretinoin monotherapy for patients with HS has limited therapeutic benefit. This is both the general overall impression of many experts as well as the outcome of a study in which a large case series of 68 patients were followed over a period of almost 9 years [7-12]. The results of case reports and studies with case series are summarized in Table 17.1.

All studies lack control groups with antibiotics or other agents as a comparison, so no statement as to relative efficacy can be made. However, in all the referred case studies many patients did not respond to oral antibiotics or surgery, or relapsed after such treatment.

It is well known that acne patients with epithelial sinus tracts with recurrent inflammation respond poorly to isotretinoin and are in fact most of the isotretinoin "failures," at a high cumulative dose of isotretinoin as well [6, 13, 14]. These lesions are identical to those found in the axillae and groin in patients with HS [13, 14].

Shalita and co-workers [13] suggested that in early cases in which only inflammatory furun-

culoid lesions exist and undermining sinus tracts have not yet developed, isotretinoin alone can produce complete suppression and prolonged remission. Boer and van Gemert [12] also found some indication that the response of HS to isotretinoin is more successful in the milder (furunculoid, papulo-pustular lesions) cases. It may be that treatment with isotretinoin at the earliest stages of HS corrects the follicular abnormality that is the root of this chronic disease [15].

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