Brief overview
- Treatment: Medication, surgery or laser therapy
- Causes and risk factors: Not conclusively clarified, probably hormonal, hereditary predisposition or due to a disturbed immune system, trigger factors intensify the disease
- Symptoms: Inflammation in the skin with palpable lumps and thickening, later pus accumulations, fistulas and scars
- Diagnosis: Medical history (anamnesis), physical examination, sampling and imaging procedures
- Course of the disease and prognosis: If left untreated, a chronic condition may develop. Complications such as blood poisoning or late effects such as a malignant skin tumor are possible.
What is acne inversa?
Acne inversa (acne inversa) is an inflammatory skin disease that is an autoimmune disease. It mainly affects regions where skin folds form easily (armpits, genital area). Large areas of inflammation, accumulations of pus and abscesses occur here.
Connecting ducts from the skin to other organs (fistulas) may also form. Acne inversa can also lead to pronounced scars and disabilities. The severity of the disease can be divided into different degrees or stages:
- Stage I: Individual abscesses have formed, fistulas and scarring are absent.
- Stage III: The abscesses occur over a large area. Fistulous tracts and scarring are formed.
Women suffer from acne inversa more frequently than men. In most cases, the disease occurs for the first time after puberty and before the age of 30.
In many cases, acne inversa occurs together with the more well-known acne vulgaris.
How is acne inversa treated?
The treatment of acne inversa is difficult and depends on the stage (severity) of the disease. Sometimes medication alleviates the symptoms and provides the patient with symptom-free or at least symptom-free phases.
Often, however, surgical interventions cannot be avoided. In general, acne inversa is treated in medical centers that specialize in skin diseases.
Medication for acne inversa
For the local wound treatment of acne inversa, the doctor prescribes antiseptic (antimicrobial) preparations in the form of solutions or ointments (for example with polyhexanide, octenidine or PVP iodine). In addition, the doctor often prescribes antibiotics to control bacterial infections, which can have a significant impact on the course of acne inversa.
Doctors sometimes treat more severe cases of acne inversa with the so-called TNF inhibitor adalimumab (TNF = tumor necrosis factor). This is a biotechnologically produced monoclonal antibody that slows down inflammatory processes in the immune system.
It is therefore also used, for example, in rheumatoid arthritis, psoriasis, Crohn’s disease, ulcerative colitis and other autoimmune diseases.
Women with acne inversa are occasionally prescribed antiandrogens. These inhibit the male sex hormones that occur in small amounts in the female body. This may have a positive effect on the course of the disease.
Other medications are used less frequently in the treatment of acne inversa, such as corticosteroids (cortisone) or acitretin.
Some sufferers may try to treat acne inversa with the help of home remedies. In general, however, the effectiveness of home remedies has not always been scientifically proven or sufficiently researched.
Home remedies have their limitations. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
Surgical treatment
Advanced acne inversa can usually only be permanently cured by surgically removing the affected areas of skin. Depending on the size of the wound and any existing wound healing disorders, three wound treatment options can be considered:
- Secondary healing: The edges of the wound are sutured together and a scar forms at the incision site. Secondary healing of acne inversa is particularly suitable for smaller areas of skin.
- Suture flap plasty: In a suture flap plasty, healthy skin is removed from the surrounding area to close the wound. The surgeon ensures that the tension created in the skin does not restrict movement.
- Split-thickness skin grafting: In split-thickness skin grafting, the surgeon removes healthy skin from the back of the head or thigh, for example, and places it in the wound. The area from which the skin is taken heals on its own, like an abrasion.
How long you are unable to work after an operation due to acne inversa depends on the severity of the disease and the healing process, for example.
Other therapeutic measures
Doctors rarely use laser therapy for acne inversa, for example to remove diseased tissue or as radiation therapy.
For example, experts recommend a calorie-conscious diet and physical exercise for acne inversa.
What is the underlying cause of acne inversa?
The exact causes of acne inversa are still unknown. Experts suspect that disorders of the immune system and hormonal influences play a role in the development of this serious skin disease. In addition, some people apparently have a hereditary predisposition to acne inversa.
It is certain that certain factors trigger or exacerbate the skin disease. These trigger factors include
- Smoking
- Severe overweight (obesity)
- Stress and psychological strain
- Sweating
- Mechanical irritation (for example due to tight clothing)
- Removal of body hair (shaving)
- Bacterial colonization of the hair follicles (especially with Staphylococcus aureus)
In addition, a connection is often observed between acne inversa and some other diseases (concomitant diseases) such as the chronic inflammatory bowel diseases ulcerative colitis and Crohn’s disease.
What symptoms does acne inversa cause?
In acne inversa, initially only the hair roots and the associated sebaceous and sweat glands become inflamed in the affected areas of skin. Palpable lumps and thickenings form, which look like enlarged blackheads.
The accumulations of pus sometimes drain spontaneously and pus, sebum or a foul-smelling secretion is released. After a few years, the affected regions are usually characterized by a large number of scars from previous foci of inflammation.
The following body regions, among others, are affected by these pathological processes of acne inversa:
- armpits
- groin
- Genital region: vulva, scrotum (scrotum)
- buttocks
- Abdominal folds
- Folds under the female breast
Acne inversa occurs less frequently on areas of the body such as the face, eyelids and back.
Acne inversa: examinations and diagnosis
It often takes years before acne inversa is diagnosed. One reason for this is that many sufferers do not go to the doctor until later due to a sense of shame. In addition, the disease is so rare that many doctors have little experience with it and therefore do not make the correct diagnosis straight away.
To clarify the skin changes, the doctor first asks the patient about their medical history (anamnesis). Among other things, he will ask the patient to describe all symptoms and complaints in detail and ask how long they have been present.
This is followed by a physical examination. For example, the doctor carefully examines the skin changes and palpates the tissue. Any fistulas are examined more closely using a probe. The doctor usually also takes blood samples to determine inflammation parameters such as erythrocyte sedimentation rate and C-reactive protein.
Swabs of the skin surface and samples from deeper tissue layers at the pathologically altered areas of skin also provide information. Any germs present can be detected in the laboratory.
The doctor uses imaging procedures to determine the depth of the disease or the fistula tracts. For example, ultrasound and magnetic resonance imaging (MRI) are used.
During his examinations, the doctor rules out other diseases with similar symptoms. These include, for example, recurring hair follicle inflammation (folliculitis), deep, purulent inflammation of a single hair follicle (boil) or several neighboring hair follicles (carbuncle) and skin tuberculosis.
What are the effects and consequences of acne inversa?
Due to the physical symptoms, acne inversa patients are severely impaired in their quality of life. In addition, the disease may have other effects that negatively impact the everyday, professional and relationship life of those affected. These include
- pain
- sleep disorders
- Obesity (obesity)
- Feeling of disgust
- Disfigurement problems combined with a feeling of shame
- Feeling of wetness, soiling of clothing (when draining pus)
- Soft tissue swelling under the skin due to a disorder of the lymphatic system (lymphoedema)
- Impaired performance
- Impairment of sex life
- Fear of secondary diseases: Anemia, development of a tumor in the anus and genital area
- Fear of stress in the family/social environment
- Fear of unemployment/financial problems
- Fear of genetic burden/inheritance
Prognosis
If left untreated, acne inversa can develop into a chronic condition that is associated with severe pain and a considerable impairment of quality of life. Many sufferers withdraw from social life and some even develop depression. It is therefore very important to be examined and treated by an experienced dermatologist at an early stage if acne inversa is suspected.
If the pathogen spreads, there is also a risk of blood poisoning (sepsis). One of the possible, but rare, long-term consequences is squamous cell carcinoma – a malignant skin tumor.
