Daoud Mathieu, Suppa Mariano, Heudens Stephanie, Daxhelet Mathilde, Njimi Hassane, Nobile Laura, Tannous Julio, Van Damme Claire, Karama Jalila, White Jonathan M, Revuz Jean, Benhadou Farida, Del Marmol Veronique
Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.
Department of Dermatology, Institut Jules Bordet, Brussels, Belgium.
Dermatology. 2023;239(5):738-745. doi: 10.1159/000530664. Epub 2023 Jul 25.
Acne conglobata (AC) and nodulocystic acne have long been confused clinically, despite the presentation and the response to treatment being different. AC and hidradenitis suppurativa (HS) resemble each other; a subtype of HS called "conglobata phenotype" has recently been reported in a large Dutch cohort. Acne vulgaris and HS are often associated. Isotretinoin is typically ineffective in treating HS and may even aggravate it, but it is often indispensable in treating acne vulgaris.
The aim of the study was to assess whether isotretinoin may be used safely in adults with both HS and acne vulgaris and when it might be contraindicated.
Belgian HS patients from the European Registry for Hidradenitis Suppurativa Registry (ERHS) reporting a history of severe acne of the face and/or the back, and who have ever used isotretinoin for their acne, were all selected. Patients whose acne worsened on isotretinoin were compared to patients whose acne did not worsen (improvement or no change).
Among the 82 selected patients, 10 (12.2%) report that their acne was aggravated while taking isotretinoin, while 72 (87.8%) report that their acne was not aggravated on isotretinoin. Of the 10 HS patients whose acne worsened with isotretinoin, 9 (90%) were men (p = 0.04) and 8 (80%) were HS "conglobata phenotype" (p < 0.001). In contrast, 47 (65.3%) of the 72 patients whose acne did not worsen on isotretinoin belonged to the HS "regular phenotype" (p = 0.01). On multivariate analysis, the item most strongly associated with poor response to isotretinoin was the HS "conglobata phenotype," followed by body mass index (BMI) (worse response to isotretinoin if BMI >25 kg/m2). Additionally, of 26 patients who received isotretinoin while their HS had already started, only 6 (23.1%) reported isotretinoin effectiveness on their HS.
Subject to confirmation by larger studies, our study suggests that isotretinoin should be avoided in the treatment of acne in HS patients with the HS "conglobata phenotype," as it may worsen the acne, likewise being male or having a BMI above 25 seems to increase this risk of a bad therapeutic outcome. Patients with an HS "regular phenotype" appear to be at a reduced risk of isotretinoin treatment worsening their acne.
聚合性痤疮（AC）和结节囊肿性痤疮在临床上长期以来一直存在混淆，尽管它们的表现和对治疗的反应有所不同。AC与化脓性汗腺炎（HS）相似；最近在一个大型荷兰队列中报告了一种称为“聚合性表型”的HS亚型。寻常痤疮和HS常相关联。异维A酸通常对治疗HS无效，甚至可能使其加重，但在治疗寻常痤疮时往往不可或缺。
本研究的目的是评估异维A酸在患有HS和寻常痤疮的成人中是否可以安全使用以及何时可能禁忌使用。
从欧洲化脓性汗腺炎注册登记处（ERHS）选取有面部和/或背部重度痤疮病史且曾使用异维A酸治疗痤疮的比利时HS患者。将异维A酸治疗后痤疮加重的患者与痤疮未加重（改善或无变化）的患者进行比较。
在82例入选患者中，10例（12.2%）报告在服用异维A酸时痤疮加重，而72例（87.8%）报告异维A酸治疗后痤疮未加重。在10例异维A酸治疗后痤疮加重的HS患者中，9例（90%）为男性（p = 0.04），8例（80%）为HS“聚合性表型”（p < 0.001）。相比之下，72例异维A酸治疗后痤疮未加重的患者中有47例（65.3%）属于HS“普通表型”（p = 0.01）。多因素分析显示，与异维A酸治疗反应不佳最密切相关的因素是HS“聚合性表型”，其次是体重指数（BMI）（如果BMI>25 kg/m2，对异维A酸的反应更差）。此外，在26例HS已经发病时接受异维A酸治疗的患者中，只有6例（23.1%）报告异维A酸对其HS有效。
有待更大规模研究证实，我们的研究表明，对于具有HS“聚合性表型”的HS患者，应避免使用异维A酸治疗痤疮，因为这可能会使痤疮恶化，同样，男性或BMI高于25似乎会增加这种不良治疗结果的风险。具有HS“普通表型”的患者，异维A酸治疗使其痤疮恶化的风险似乎较低。
