While isotretinoin (Accutane) isn’t a first-line treatment for hidradenitis suppurativa (HS), it may help improve your symptoms in some cases. For instance, a clinician may prescribe it off-label for treatment-resistant HS.
HS is an inflammatory skin condition that causes acne-like bumps and lesions. It develops when hair follicles become clogged and eventually burst, creating painful lumps or abscesses. These bumps usually show up where skin meets skin — your armpits or groin, for instance — and they’re often painful.
Treatment for HS often involves antibiotics and steroid medications, but these may not always work. If your symptoms aren’t improving, your care team may recommend other treatment options, including isotretinoin.
Below, get the details on isotretinoin for HS and whether it may be a helpful option for you.
Isotretinoin has several brand names, including Accutane.
While Accutane is no longer on the market in the United States, some people still use this name for the medication.
Acne and HS can appear very similar. In fact, if you have both conditions, you might not realize two different inflammatory processes are actually at work.
That’s one reason why, in the quest for finding HS treatments, isotretinoin seemed to be a logical next step. After all, it made a major difference in symptoms for people living with acne.
Yet evidence supporting its benefits for HS remains fairly mixed.
A small 2017 study with 25 participants living with HS found 68% of them experienced at least partial remission of symptoms with isotretinoin therapy. This treatment seemed most effective among younger female participants who had mild HS and also had acne.
The study sparked an expert commentary, which considered results from seven similar studies. The review found no clear reason to use isotretinoin for HS, but the commentary did note that some benefit for specific cases may exist.
In a 2019 study including 209 participants, people with a history of pilonidal cysts said they had more success with isotretinoin treatment.
To sum up, while off-label use of isotretinoin may improve symptoms for a small number of people living with HS, a dermatologist or other doctor likely won’t recommend it as a first approach to treating HS.
Your prescribing clinician may add isotretinoin to your treatment plan if you have both severe acne and HS, especially if other approaches haven’t helped reduce your symptoms.
Since isotretinoin can help manage acne, you may notice some overall improvement in inflammation and irritation.
Your doctor or clinician may also prescribe this medication if they believe you have severe acne. That’s why it’s always helpful to describe your symptoms in as much detail as possible, including:
- where the bumps show up
- how long they last
- whether they feel painful, leak pus, or leave scars
Giving your care team as much information as possible about your symptoms can help them make an accurate diagnosis.
Like many medications, isotretinoin does come with a risk of side effects.
Some of the most common side effects include:
- dry lips and skin
- dry mouth, nose, and eyes
- sun sensitivity
- skin itching and irritation
- thinning hair
- aches and pains in your joints and bones
- upset stomach
- laboratory abnormalities, like elevated blood triglyceride levels
Isotretinoin has a boxed warning from the Food and Drug Administration (FDA). This is the highest cautionary statement the FDA issues on product labels.
Isotretinoin may have serious side effects if you’re pregnant or become pregnant, including:
If you’re able to become pregnant, you must have two negative pregnancy tests before receiving a prescription. You’ll also need to use two forms of birth control and take a monthly pregnancy test while taking isotretinoin.
What about suicide risk?
That said, no clear evidence specifically links isotretinoin to an increased risk of depression or suicide. Some research even suggests people taking isotretinoin may have a lower risk of suicide attempts.
Of course, it’s always wise to talk with your care team about any mental health symptoms you experience, especially when starting a new medication.
Need help now?
If you’re having thoughts of suicide, you can get free, confidential support right now.
You can connect with compassionate crisis counselors by dialing 988 to reach the Suicide and Crisis Lifeline.
If you prefer to chat over text, you can also text “HOME” to 741-741 to reach a crisis counselor at Crisis Text Line.
You can connect with these helplines 24/7, 365 days a year.
One concern about using isotretinoin to treat HS is that it could potentially make symptoms worse.
This medication works by decreasing the size and activity of sebaceous glands, which are almost always located alongside a hair follicle — and HS develops, as noted above, when your hair follicles become clogged.
Some experts believe isotretinoin may increase the chances of hair follicles becoming blocked. In one small 2019 case series including eight people taking isotretinoin for severe acne, all participants developed symptoms consistent with HS.
There’s no cure for HS, but you do have options for managing your symptoms. In some cases, your symptoms may go into remission.
Overall, treatment goals include reducing your symptoms, managing pain, and preventing HS from getting worse. The type of treatment that’s right for you typically depends on the severity of your symptoms.
- avoiding overheating and sweating, when possible
- treating emerging lumps with warm compresses
- washing your skin with an antimicrobial wash
- opting for laser hair removal over shaving or waxing
- using mild antiperspirants
- wearing loose clothing
- avoiding scrubbing your skin
Isotretinoin, which is sometimes still called by the brand name Accutane, is not a first-line treatment for HS. It may be helpful if you also have severe acne or other conditions, but in some cases it may make your HS symptoms worse.
Still, you have a number of other options for treating HS, including antibiotics, anti-inflammatory medications, and natural remedies.