First of all, what you're going through sounds absolutely exhausting and painful, and it makes complete sense that the hormonal shift from changing birth control has hit your HS so hard. Hormonal changes are a well-known HS trigger, and you're clearly dealing with the fallout in a big way.
On isotretinoin — the evidence is Show Full Answer
First of all, what you're going through sounds absolutely exhausting and painful, and it makes complete sense that the hormonal shift from changing birth control has hit your HS so hard. Hormonal changes are a well-known HS trigger, and you're clearly dealing with the fallout in a big way.
On isotretinoin — the evidence is genuinely mixed. In one study of 358 people with HS:
- 77% reported no improvement
- 7% reported their HS got worse
- 16% reported improvement
A smaller study showed more promise, with 68% seeing a complete or partial response. So it works for some, but it's far from a sure thing for HS specifically.
There are also important risks to know about:
- It can affect liver enzymes and blood lipid levels
- It cannot be taken during pregnancy due to severe birth defect risks
- Given your blood clot history and current medications, this is especially something to discuss carefully with your doctor Since you're already on Bimzelx (a biologic) and topical clindamycin, here are other options worth discussing with your dermatologist:
- Oral antibiotics like doxycycline, minocycline, or a combination of oral clindamycin and rifampin — especially useful for widespread flares
- Steroid injections directly into lesions to reduce inflammation and swelling quickly
- Acitretin (Soriatane), another retinoid that works differently than isotretinoin — though evidence is also mixed, and it comes with its own side effects like back pain and increased sensitivity
- Hormonal therapies — since your flares worsened after your birth control change, it's worth asking your dermatologist and the doctor managing your blood thinners whether any hormone-related options are safe given your history
- Pain management — your doctor can help with prescription pain relief so you can actually function day-to-day
- Surgical options for severe or persistent areas, including laser treatments or removal of affected tissue
For immediate relief at home, warm compresses on active lesions can help bring them to the surface and ease pressure pain. Over-the-counter options like acetaminophen and ibuprofen (taken together at max recommended doses for a few days) may also help — though check with your doctor first given your blood thinner use.
Please don't wait to contact your dermatologist about escalating your treatment plan. What you're describing is severe and you deserve more relief than you're currently getting. 💙
May 16
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