Most people are familiar with acne as a disease of the skin, which leads to more or less severe visual impairment of the skin texture. For this reason, especially many young people in the pubescent age fear to develop a so-called acne inversa.
What is acne inversa?
Behind the name acne inversa is a skin disease. Acne inversa is an inflammatory process that affects certain functional parts of the skin. Behind the name acne inversa hides a skin disease. Acne inversa is an inflammatory process that refers to certain functional parts of the skin and is limited to different physical regions. According to the definition, acne inversa involves inflammatory foci that refer to the sebaceous glands located under the skin and the so-called hair follicles. Both men and women can suffer from acne inversa. However, in the majority men suffer from this skin disease.
Causes
When researching the causes that lead to the development of acne inversa, physicians have come across various factors. However, there are still uncertainties regarding the definite causes of acne inversa. It is believed that acne inversa is favored by the consumption of nicotine. In addition, acne inversa may be a consequence of obesity. For this reason, acne inversa is also called sweat gland abscess. Hereditary criteria also play a role in the pathogenesis of acne inversa. It has been proven that acne inversa occurs more frequently within a family. An influencing factor, which takes microorganisms into account, is also to be included as a cause in acne inversa. In this reference it is predominantly infections with bacteria for the course and the expression of acne inversa with responsible.
Symptoms, complaints and signs
Acne inversa is a serious disease, which can lead to a severe restriction of the quality of life. In complicated courses, even the development of life-threatening sepsis is possible. Both sexes are equally affected, whereby the multiple abscesses are usually located in the anal region in men and often under the armpits in women. The disease can be divided into three stages. In stage I, multiple skin abscesses occur that do not scar or form fistulas. They are giant comedones (blackheads) that appear as rough and palpable nodules in the skin. In stage II, recurrent abscesses are observed that tend to form fistulas. Pus, sebum, or foul-smelling secretions may be removed by squeezing. Stage III is characterized by extensive involvement of a body region with multiple abscesses. The fistula tracts that have developed interconnect. In addition, there are scarred areas from previous burned-out abscess foci. Acne inversa is characterized by chronic pain, restricted mobility and psychological abnormalities. Furthermore, the constantly occurring symptoms can often lead to long absences from work, so that the disease is recognized as a disability under social law. The sufferers often suffer from social stigmatization due to the long periods of absence and are prone to depression. The constant abscesses can also lead to life-threatening complications such as sepsis (blood poisoning).
Diagnosis and course
The courses of acne inversa vary from individual to individual. At the beginning of acne inversa, suppurating blackheads form, which can develop into inflamed nodules and later become abscesses. Acne inversa is characterized by several relapses, so that the periods between the individual relapses can be very long or quite short. In most cases, depending on the depth and extent of the skin irritations, acne inversa shows severe or mild inflammation. However, the skin tissue affected by acne inversa usually heals with scarring. In addition, so-called fistula ducts can form in acne inversa. Individual patients do not always complain of painful symptoms, but feel severely affected physically and psychologically. The specialist (e.g. dermatologist) recognizes the presence of acne inversa already by the visual assessment of the skin and the medical history, which the affected person recites.
Complications
The psychological burden associated with acne inversa is particularly great.Those affected are often ashamed of the unsightly skin areas, they withdraw and may also be socially excluded. Depression and/or problems in relationships may follow. Acne inversa can be accompanied by severe pain, tissue shortening and scarring, which can lead to movement restrictions. Consequently, everyday life becomes more difficult and absences from school or work may occur. Relatives may also be overwhelmed with the situation. Bacteria can float into the bloodstream from inflammatory foci of acne inversa. The risk of a generalized infectious disease, a so-called blood poisoning (sepsis) is increased. Sepsis is accompanied by the symptoms of rising fever, chills, redness, swelling, severe pain, hyperthermia at the site of infection, and severe feeling of illness. Sepsis must be treated immediately. Other complications associated with acne inversa may include recurrent local inflammation and chronic swelling. Certain cancers (squamous cell carcinoma) may also be associated with acne inversa. Acne inversa may also be associated with sleep disturbances, obesity, a feeling of disgust, a feeling of wetness, a disfigurement problem associated with a feeling of shame, and an impairment of sexual life. In addition, there may be soft tissue flooding under the skin due to a disorder in the lymphatic system.
When should you see a doctor?
For people affected by acne inversa, a visit to the dermatologist is recommended already in the first of three possible stages. The sooner this severe form of acne is diagnosed and treated professionally, the better the dermatologist can manage the painful skin condition. But often enough it takes a long time before the correct diagnosis is made. Already the pain of the first stage of acne inversa justifies seeing a specialist in skin diseases. However, it often happens that this stage is not recognized as acne inversa. This is partly due to the fact that acne inversa occurs less frequently compared to other forms of acne. Nowadays, however, this skin disease is known to most dermatologists. Nevertheless, it is recommended to consult an experienced dermatologist in order not to be exposed to a misdiagnosis. Under no circumstances should the affected person push around the inflamed and swollen pus foci. The sooner acne inversa is correctly recognized and professionally treated, the less the affected person has to suffer. In the first stage of acne inversa, the doctor can still treat conservatively with antibiotics. Women may receive antiandrogen therapy. In the two later stages, surgery or laser treatments are often necessary. If fistula formation is suspected, the treating physician may order an X-ray contrast examination.
Treatment and therapy
After acne inversa is also clarified by microbiologically examined smears or X-ray examinations, treatment can begin. A wide variety of methods can be used in the therapy of acne inversa. If there is no improvement, surgical interventions are also used against the disease. The severely festering acne lesions can be surgically opened. Among the lighter and not so radical treatment options against acne inversa are a change in diet, moist warm compresses, bathing and hydrotherapies. Fortification of the diet with vitamin A and zinc gluconate can also alleviate acne inversa. Targeted medications, which are enriched with corticosteroids, for example, and are injected directly into the skin, have also proven effective in therapy. If there is extensive bacterial inflammation, antibiotic drugs can be prescribed. In addition, to control hormonal causes of acne inversa, antiandrogenic procedures are used.
Outlook and prognosis
When treated as prescribed with prescribed medications, the skin appearance progressively improves. The prospect of cure increases if the affected areas of skin get enough air and do not sweat too much. As with many skin diseases, the cause of acne inversa is not completely clear. Thus, there is always hope that the disease will disappear by itself one day. Whether the cure is permanent remains to be seen and depends on many criteria, including the hormone status and lifestyle of the sufferer. Without treatment, the disease continues to progress.Pustules turn into eczema and abscesses, which make medical treatment absolutely necessary. If you do not go to the doctor, you risk spreading the bacteria from the acne pustules further in the body via the bloodstream. This leads to the outbreak of acne on other parts of the skin. Here the prognosis looks much worse. A complete cure is impossible, because the disease gets too many outbreaks. Especially with acne inversa, a connection with smoking is suspected. Over 80% of those affected are smokers. Those who give up smoking and treat the acne carefully usually notice a significant improvement in the clinical picture very quickly. The prospect of complete healing is then best.
Prevention
Helpful tips for prevention of acne inversa are not easy to give, especially since preventive options are extremely limited. In any case, in order to avoid an expansion of the inflammatory processes and, consequently, a worsening of the condition, professional treatment is preferable. This applies in particular to the frequently performed opening of pus foci. The risk of developing acne inversa can be limited by maintaining a healthy body weight and not consuming nicotine. In women, early drug treatment against the predominance of male hormones can prevent acne inversa in individual cases.
Aftercare
Acne inversa is a long-lasting disease that is often chronic. After successful treatment, all factors that promote a relapse and flare-up of the disease should be avoided. A skin care routine that keeps the skin clean but does not overly stress it is helpful. Regular cleansing of the skin with a mild detergent and a disposable washcloth is recommended. Good results are also achieved with micellar-based cleansers applied to the face with a cotton ball. The causes of acne inversa have not been conclusively clarified to date. However, since at least statistically there is a high correlation with nicotine consumption and obesity, these factors should also be taken into account in follow-up care. Those who have stopped smoking during therapy are better off not starting again later. Overweight patients must reduce their weight. The greatest success is promised by a change in diet to a largely plant-based diet in conjunction with regular physical activity. A healthy diet that includes plenty of fresh fruits and vegetables in addition to whole grain products generally has a favorable effect on the condition of the skin. When using personal care products and makeup, care should be taken to use only fat-free, non-comedogenic products. If scars have formed during the disease, they can be treated as part of aftercare.
What you can do yourself
Acne inversa can be effectively treated only by surgical intervention. However, the discomfort and everyday problems associated with the disease can be treated by taking some precautions and home remedies. First of all, increased personal hygiene is recommended. Affected areas should be cleaned regularly with a disposable washcloth and mild washing lotions. The dermatologist can also prescribe light ointments to reduce itching and other symptoms. What should be avoided is hair removal by waxing or epilation. Aggressive peelings are also better avoided, as these can additionally irritate the skin. In addition, those affected should stop smoking. Cigarette consumption can cause more bacteria of the Staphylococcus aureus type to colonize the skin – the result is an increase in acne and worsened wound healing. Lastly, dietary measures are recommended. On the one hand, this helps to exclude overweight as a risk factor. On the other hand, a healthy and balanced diet without fast food and stimulants contributes to a better skin appearance and an increased immune defense. If severe inflammations should nevertheless form, it is important to consult a doctor and have the acne inversa professionally removed.
