Drug Survival of Oral Retinoids in Hidradenitis Suppurativa: A Real-Life Cohort Study

Abstract

Introduction Cohort studies on the use of retinoids for hidradenitis suppurativa (HS) have yielded contradicting results. As the clinical presentation of HS is heterogeneous, with different predilection sites and hallmark features, it can be hypothesized that HS phenotypes are associated with the effectiveness of specific retinoid treatments. Objectives The aim of this study was to evaluate the drug survival of oral retinoids in the treatment of HS and to establish predictors for longer treatment duration. Methods A retrospective, dual-center study was conducted in the Netherlands in adult HS patients treated with oral retinoids between 2011 and 2021. Drug survival analyses were performed through Kaplan-Meier survival curves. Additionally, Cox regression models were used to determine predictors for a longer drug survival. Results In total, 102 patients were included. Overall drug survival of (low-dose) isotretinoin ( n = 66) at 12 and 24 months was 44.2% and 15.5%, respectively. Termination of treatment was mostly due to ineffectiveness (26%). Presence of widespread comedones ( p = 0.03) and the use of concomitant systemic medication ( p = 0.04) were associated with a prolonged treatment duration. For acitretin ( n = 36), the overall drug survival was 42.0% at 12 months and 37.4% at 24 months, and was also predominantly determined by ineffectiveness (28%). Interestingly, the scarring folliculitis phenotype ( p < 0.05) was associated with prolonged drug survival time for acitretin treatment relative to the regular phenotype. Conclusion Comparable drug survival rates at 12 months for isotretinoin and acitretin were found. HS patients with widespread comedones and the scarring folliculitis phenotype could benefit from treatment with isotretinoin or acitretin, respectively. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-022-00725-9.

Topical and Systemic Retinoids in the Management of Hidradenitis Suppurativa: A Comprehensive Literature Review

“…Some patients, particularly those with the folliculitis scar phenotype, experienced a more prolonged drug survival duration with acitretin therapy compared with those with the typical phenotype. These results indicate that the effectiveness of retinoids can vary significantly among patients and may be influenced by specific clinical characteristics [51].…”

“…It is important to select a phenotype that may respond to isotretinoin treatment, such as patients with Hurley I and II who have acne vulgaris as the primary cutaneous manifestation [46,[51][52][53].…”

The Pathogenesis and Treatment of Hidradenitis Suppurativa

“…The literature is divided on which drug is superior for the treatment of HS, with some studies reporting greater efficacy with acitretin [ 21 , 23 ] and others reporting isotretinoin showed greater benefit [ 8 , 22 ]. Acitretin acts on keratinocytes and decreases hyperkeratosis and has also been demonstrated to decrease the levels of Th-17 cells [ 8 , 29 ]. Isotretinoin is a vitamin A analogue that acts primarily at the sebaceous glands to modulate their secretions [ 29 ].…”

“…Acitretin acts on keratinocytes and decreases hyperkeratosis and has also been demonstrated to decrease the levels of Th-17 cells [ 8 , 29 ]. Isotretinoin is a vitamin A analogue that acts primarily at the sebaceous glands to modulate their secretions [ 29 ].…”

Immune Dysregulation and Current Targeted Biologics in Hidradenitis Suppurativa

“…Intralesional Kenalog injections may also be administered to alleviate pain and inflammation and reduce the size of active lesions [30]. Other treatments that have been utilized include photodynamic therapy, laser hair removal, botulinum toxin, and retinoids [31][32][33][34]. Despite the wide variety of available therapies, they have variable efficacy in inducing disease remission.…”