Keratolytics

HS is a disease of the hair follicle with histological signs of poral occlusion [9-11]. Although there are only a few publications about the use of keratolytics in HS [12, 13], the follicular occlusion brought about by hyperkeratosis may be a therapeutic target. Therefore, by analogy to acne, this also appears to be a good target for keratolytics. In acne, another disease of the follicle with abnormal keratinization (microcom-edo), the mainstay in classical therapy of early lesions is topical treatment with peeling agents, especially topical retinoids [8, 14, 15]. Here, the rationale is that all acne lesions arise out of a comedo and so it makes sense to treat acne patients with comedolytic agents [8, 14, 15]. Topical comedolytic agents are also recommended for use in maintenance therapy in acne by some authors [8, 14, 15].

Although topical retinoids such as tretinoin, isotretinoin, adapalene and tazarotene are strongly recommended in the management of most patients with acne vulgaris, there are currently no reports about the use of these comedolytic agents in HS. One possible reason for this is that the relatively weak peeling effect (considered as a side-effect) of topical retinoids is not strong enough for therapy of HS lesions. Another reason could be that physicians do not believe that a topical peeling agent can have any therapeutic influence on deep-seated nodules and sinus tracts of HS.

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