Accutane is a dermatological drug which virtually no dermatologists will prescribe..
Perhaps so - I am certainly not trying to make the argument that accutane is benign. I am instead arguing that:
a) Ilaris has arguably worse side effects. I don't even think it is that arguable (e.g. likely hospitalization rates) - but regardless lets call it a wash.
b) Strong efficacy in gout is undoubtedly treated by the FDA as more important than similarly strong efficacy in acne.
If the IL-1 drugs were rejected in gout (where both had very strong efficacy) then I don't think it likely that using them in acne (or, by extension, another IL-1 drug) is likely to get approval. Hence my puzzlement over even trying in that indication.