What is Acne Inversa?

Acne inversa is common worldwide and affects both the female and male sex. In men more often than in women, this skin disease occurs in the anal area, but it also occurs in other areas of the body. The disease can manifest from puberty to old age. A non-representative survey of patients by the Deutsche Interessengemeinschaft Akne inversa e.V. showed that the disease usually breaks out by the age of 30.

What does acne inversa mean?

The manifestations of “acne” (Greek akme (tip), Latin acne, exact origin of the term unexplained) refer to chronic skin diseases associated with pimples, abscesses, fistulas and scarring. “Inversa” means “reversed”, because contrary to the “youth disease” known to many people, acne inversa does not occur on the face, but almost exclusively in the anal, genital, inguinal and axillary areas. The term hidradenitis suppurativa (sweat gland abscess) has become established as a synonym for this disease. However, this is misleading, as acne inversa is primarily not an inflammation of the sweat glands, but of the sebaceous glands.

When is acne inversa referred to?

The disease is divided into three stages, the so-called “Hurley stages”. They allow an assessment of the current severity and further progression of acne inversa:

  • In stage I, milder skin changes are noted: The sporadic, typical black spots (comedones) grow into larger protrusions (giant comedones). If bacteria graft on, pus capsules, so-called abscesses, develop. These are warm, red and painful. If you squeeze abscesses, pus, sebum and a foul-smelling liquid empties.
  • In stage II, abscesses form more frequently and in several places, but have no connection to each other. Fistula tracts and scarring may also occur.
  • In the last stage III, the affected areas of the body are affected over a large area, due to the many abscesses, scarring occurs. The inflamed areas are connected by passages under the skin, so-called “fistulas”, and lead repeatedly to abscesses.

In the first stage, acne inversa can be confused with acne conglobata. This form of acne, unlike the special form of acne inversa, belongs to the “ordinary” forms of acne (acne vulgaris). In this case, inflammations, pimples, abscesses and fistulas also develop on the face as well as on the back, arms and legs. The conglobata form refers to a severe course with the formation of larger nodules extending deep into the skin and multiple fusing abscesses.

Who treats acne inversa?

If you suspect that you may be suffering from acne inversa, you should first be examined by your family doctor. He or she can then refer you to a specialist in skin diseases, a dermatologist.

What helps to treat acne inversa?

Unfortunately, there is no therapy that leads to a complete cure. However, the symptoms can be alleviated by various measures. First, known risk factors should be eliminated. For example, smoking represents one of the most important factors of acne inversa, as nicotine promotes skin inflammation and impedes healing. Obesity is also a notable risk factor. Various ointments and solutions for application to the inflamed areas lead to healing. They contain alcohol or ammonium and prevent colonization with bacteria. If it is too late for this, antibiotic creams, such as clindamycin, can also be applied. Herbal remedies can also be found on the market. If you have questions about homeopathy for acne inversa, it is best to consult your treating physician. Depending on the stage, further medication or even surgery may be necessary.

Stage-dependent therapy for acne inversa.

In stage I, antibiotics are used. Common preparations are clindamycin and rifampicin. These are taken as tablets or injected through the vein to fight skin inflammation caused by bacteria. Other medications used for acne inversa include immunosuppressants such as the active ingredient infliximab. Immunosuppressants influence protein production at the DNA level and can thus curb the overproduction of skin cells and thus the keratinization and blockage of the excretory ducts.Depending on the severity of the findings, these preparations are also administered as tablets or via the vein. In women, anti-androgenic medication can help in some cases. The preparations, for example ethinylestradiol or cyproterone acetate, reduce testosterone levels, which has a positive effect on inflammation. All of these medications require a prescription, have numerous side effects, and should be taken only after consultation with a physician.

When is surgery necessary?

In stages II and III, larger skin lesions must be excised by a dermatologist. Depending on how extensive the procedure becomes, surgery may be performed under local anesthesia and on an outpatient basis, or general anesthesia followed by hospitalization may be required.

Other forms of therapy for acne inversa

In addition to the conventional technique using a scalpel, laser procedures are also used. When which technique is used depends on the size and depth of the skin lesion. In many skin diseases, light therapy (photodynamic therapy) has a positive effect. However, experts do not recommend its use for acne inversa, as it has been shown to be ineffective. Therapeutic irradiation is also not recommended due to the side effects of X-rays (radiation dermatoses, tumor development).

lAight


-Therapy as an alternative method of treatment.

However, an alternative method has been approved in Germany since April 2017: The so-called lAight


therapy uses electromagnetic waves, or more precisely a combination of light and radiofrequency waves, which have an anti-inflammatory and growth-inhibiting effect. Here, the harmful UV-A and UV-B rays of light are not used. The method can be used for all stages of acne inversa, whereby the effect is more pronounced the earlier the therapy is started. The therapy can also have a positive effect on already existing scars. So far, the technique is only used in special wound centers and doctors’ offices, and the costs must be borne by the patient. If you have any questions about this relatively new procedure, contact your treating dermatologist.

Is acne inversa contagious?

Acne inversa is not contagious. However, a familial cluster is observed and therefore a genetic component is considered very likely. However, genes are not the sole cause.

Reasons for acne inversa

The causes of acne inversa have not been definitively determined. It is assumed that an overproduction of skin, i.e. cornification (hyperkeratosis), in the affected regions is the trigger. The excess skin cells clog the hair ducts of the skin, and waste products can no longer be discharged. Inflammation under the skin surface is the result. This inflammation under the skin causes a permanent-recurring (chronic-recurrent) inflammatory disease of the hair roots and sweat glands and the surrounding skin layers. It is therefore understandable why the armpits and intimate areas are particularly affected – this is where pronounced body hair and sweating come together. If bacteria from the body’s own skin flora join in, the inflammation becomes even worse in many cases. Another possible trigger for acne inversa can be a mechanical irritation caused, for example, by rubbing underwear, the pants or the bra on the skin.

Diet for acne inversa

There is no direct link between dietary habits and acne inversa. However, it is known that obesity negatively affects the course of the disease. A healthy and balanced diet is therefore important. The increased secretion of insulin also seems to have an influence. This is the case when blood sugar rises rapidly, i.e. with foods containing rapidly available sugar (carbohydrates), for example very sugary foods or white flour. Very fatty food is also not advisable. This not only leads to weight gain, but the omega-6 fatty acids contained are also suspected of promoting inflammation in general.

Acne inversa – what now?

The treatment of acne inversa is difficult and a definitive cure is not possible. Affected individuals suffer from the consequences of inflammation, scarring, cosmetic effects and pain. It is not uncommon for these patients to develop depression, become discouraged and depressed in the face of the hopeless prognosis.However, as demonstrated, there are many ways to treat the individual findings and alleviate symptoms with the prospect of containing the disease.