Nightmares caused by isotretinoin in treating hidradenitis suppurativa: a case report and clinical insights

Isotretinoin, widely used for treating severe acne, has also been prescribed off-label for hidradenitis suppurativa (HS). While effective in some cases, isotretinoin is known to cause psychiatric side effects. This case report discusses a 24-year-old male with HS who developed severe nightmares after the isotretinoin dosage was increased. Initially prescribed to manage his HS symptoms, the drug led to vivid, distressing nightmares that significantly disrupted his sleep, resulting in the discontinuation of treatment. The symptoms resolved upon cessation of isotretinoin, and a probable association was confirmed using the Naranjo algorithm. The patient was later transitioned to adalimumab, a biologic therapy for HS. This case highlights the need for careful psychiatric monitoring during isotretinoin therapy and emphasizes the importance of considering alternative treatments in cases of intolerable side effects. Further research is necessary to better understand the psychiatric implications of isotretinoin, including sleep disturbances like nightmares.