Acne inversa

Synonyms: Hidradenitis suppurativa, Pyodermia fistulans sinifica, Acne tetrade English: acne inversa, hidradenitis suppurativaAkne inversa is a skin disease that mainly affects areas with many sweat glands. These include especially the armpits, the skin under the breasts, the inside of the thighs, the groin and genital region. In these areas, acne inversa can lead to chronic abscesses, cysts and severe infections with wounds, some of them the size of tennis balls, which cause corresponding scarring.

Acne inversa is not contagious. Acne inversa has nothing in common with the commonly known clinical picture of acne, which is characterised by the frequent appearance of pimples on the face, especially during puberty. In fact, acne inversa is a skin disease whose origin is not clear.

It is suspected that it is a genetic disease which can be further aggravated by certain behaviours. Often acne inversa begins with harmless pea-sized nodules or tiny inflammations in the flexor regions of the body, where there are many sweat glands and two skin areas lie on top of each other, usually in the armpit, groin or genital area. With the appropriate inclination, these inflammations of special sweat glands around the hair follicles can spread further and lead to abscesses, which can be as big as a tennis ball.

In addition to these extremely painful swellings, there is often also a dark discoloration of the skin above the abscesses. If the abscess opens up, a frequently foul-smelling secretion emerges. In the further, more severe course of acne inversa, fistulas can also develop.

Fistulas are ducts filled with pus or wound secretion that were not previously present in the body and are formed by the disease. These fistulas often require surgical treatment and can leave large scars. The combination of symptoms often leads to the affected persons withdrawing and socially isolating themselves, which further increases the suffering of the diseased.

First of all, all the above-mentioned risk factors such as smoking or overweight should generally be avoided so that acne Iiversa can possibly regress. Depending on the severity of the disease, it can be treated more conservatively or surgically. Conservative treatment with medication includes the administration of antibiotics and corticosteroids.

Sometimes the onset of acne inversa can also be favoured by an increased amount of male sex hormones. In this case, therapy with antiandrogenic drugs is recommended to lower the level of male sex hormones in the blood. Further therapeutic approaches consist in the intake of vitamin A and zinc preparations.

A new therapeutic approach, which is particularly widespread in Europe, consists in the irradiation of the affected skin areas by the radiologist. However, the risk of skin cancer caused by radiation must be taken into account. If the problems occur chronically and fistula formation leads to severe accumulation of pus and extensive painful inflammation, surgery is often the only option.

In this operation the infected areas are cut out over a large area. If the wound does not heal on its own or if the area that has been cut out is too large, the defective area must be covered by a flap of skin from another part of the body. As already mentioned, the cause of acne inversa is still unknown.

However, it is suspected that acne inversa is caused by a cornification disorder of the uppermost skin layer (epidermis). This means that the uppermost skin cells, the so-called horny cells, continue to proliferate uncontrollably and thus clog the ducts of the sweat glands on the hair. This blockage leads to inflammation, which can be colonized by bacteria.

This causes the cracks and abscesses in the skin that are characteristic of acne inversa. Furthermore, it is assumed today that the development of acne inversa is genetically determined. This is indicated by the frequent occurrence within certain families.

But also other risk factors may favour the development of acne inversa. These include smoking and overweight. Overweight patients are more likely to develop acne inversa due to the moisture in skin folds.

As with most skin diseases, stress, incorrect or tight clothing, and incorrect and unhealthy nutrition can also promote or worsen acne inversa. It often takes a long time to make the correct diagnosis of acne inversa, as acne inversa can easily be confused with other conditions such as fungal infections or simply abscesses of the sweat glands. To make sure that the symptoms are really acne inversa, a tissue sample should be taken from an affected area, which can then be examined in detail under a microscope by a dermatologist.

Since it is assumed that the development of acne inversa is mainly genetically determined, there are few prophylactic measures. However, it is known that both smoking and being overweight promote the development of acne inversa, so these behaviours should be avoided. The scars resulting from the disease can lead to contractures and fibrosis, so that mobility is restricted.

If the fistulas, which occur mainly in the severe chronic stage of acne inversa, are not treated, skin cancer can develop. It can also lead to severe infections, anaemia, sepsis and multiple organ failure, so that acne inversa can be potentially fatal. However, this is rare today, as the infections can be treated well with antibiotics or surgery. Anti-inflammatory drugs such as Infliximab or Etanercept are currently being tested in clinical trials, which are expected to lead to new treatment success.