Summary Background The management of hidradenitis suppurativa (HS) is still challenging, and new treatment methods are necessary. Acitretin seems to be a promising agent in HS management; however, literature data are limited. Objectives To investigate the clinical efficacy of acitretin monotherapy in 17 patients with long‐standing and recalcitrant HS. Simultaneously, an assessment of quality of life was carried out. Methods The study was conducted with a group of 17 patients with HS. Patients were treated with acitretin for up to 9 months and examined at baseline, after 1 month, and then every 3 months from baseline. The clinical extent of disease severity was measured with the HS Severity Index (HSSI), Hurley scoring system, Physician's Global Assessment and Dermatology Life Quality Index (DLQI). Results Nine patients (53%) finished the whole 9 months of acitretin treatment. The mean acitretin dose was 0·56 ± 0·08 mg kg−1 daily. A significant improvement of clinical manifestation (HSSI, DLQI) was observed after only 1 month of therapy, and further improvement was recorded during the next few months. Overall, eight subjects (47%) fulfilled the criteria for response (HSSI ≥ 50% reduction from baseline). The dropout rate was 47%, due mostly to drug ineffectiveness and adverse events. Discontinuation of treatment resulted in deterioration or relapse of HS 2–8 months after acitretin cessation, in all but one patient. Conclusions HS treatment with acitretin seems to be a promising method of disease management. However, due to the high daily dosage, its usage may be limited. What's already known about this topic? In contrast to isotretinoin, acitretin seems to be a promising treatment for management of hidradenitis suppurativa. What does this study add? This study is the largest open‐label trial to date on acitretin treatment for hidradenitis suppurativa. Evaluation of quality‐of‐life aspects during acitretin therapy was also conducted.