Acne Inversa

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Acne inversa

Acne inversa is a relapsing chronic skin disease. This causes painful inflammation that can develop into lumps, abscesses and fistulas. Primarily affected are areas of the body that are rich in hair follicles and sweat glands and that are wrinkled - especially in the armpits and groin, anal and genital regions. The first lesions usually appear after puberty - an average of around 23 years of age. Women are two to five times more likely to be affected than men.

navigation

• Continue reading
• more on the subject
• Advice, downloads & tools
• Acne inversa - what is it?
• What are the symptoms?
• What complications can arise?
• How is acne inversa diagnosed?
• How is the treatment carried out?
• Whom can I ask?
• How are the costs going to be covered?

In Western Europe, around one percent of the population suffers from acne inversa, which is also known in medical circles as hidradenitis suppurativa (HS). The disease typically breaks out in early adulthood. The painful, often oozing skin lesions represent a massive burden for many affected people, which can cause mental problems as well as physical complaints.

Acne inversa - what is it?

The causes of this phased disease are still unclear. Disorders of the immune system and hormonal influences may play a role. What is certain is that the disease can be triggered or intensified by certain factors. These so-called triggers include:

• Smoke,
• Obesity,
• Inflammation of the hair follicles,
• bacterial colonization of the hair follicles (especially with Staphylococcus aureus),
• hereditary predisposition,
• heavy sweating,
• mechanical irritation (e.g. strong friction).

It all starts with the closure of a hair follicle at the junction of the sebum glands and the so-called apocrine glands - ie sweat glands that secrete parts of their cells in addition to sweat. This should lead to a build-up of sebum and sweat secretions, which leads to deep-seated inflammation with abscess formation in the area of the sweat glands. As a result, the affected sweat glands are destroyed. Branched, tubular ducts develop that make their way to the surface of the skin or grow in the skin and subcutaneous tissue. Sometimes fistula ducts ("lip fistulas") develop, which are lined with epithelium and secrete a secretion to the outside.

Depending on the severity, the disease is divided into three stages (according to Hurley):

• Stage I: individual abscesses, no fistulas and scarring;
• Stage II: one or more widely spaced abscesses with fistulas and scarring;
• Stage III: extensive involvement with abscesses, fistulas and scarring.

What are the symptoms?

At first, a single, painful lump usually forms in the skin or subcutaneous tissue. It can either heal on its own, persist, or turn into an abscess. Abscesses can merge deeply and spontaneously break through to the outside. Purulent and / or watery-bloody secretions emerge. At first, the inflammatory lesions often resolve on their own, but gradually they become chronic. Large reddish discolored, nodular, honeycomb-like areas with abscesses and fistulas develop, which are associated with the formation of scars and nodules.

Typically, acne inversa shows a symmetrical distribution and mainly affects wrinkled skin regions rich in sebum and apocrine sweat glands: groin, armpit, buttocks, anus, perineum and thighs as well as under the female breast. Acne inversa rarely occurs in other parts of the body such as the face, hairy scalp or back.

Axillary acne inversa is equally common in both sexes. On the other hand, changes in the genital and groin area are more common in women and in the genital and anal area in men.

Last but not least, the illness also represents a considerable psychological burden for those affected. The skin lesions are often experienced as severely stigmatizing. This often results in social withdrawal and isolation of the patient, not infrequently the development of depression.

What complications can arise?

A wide variety of complications can occur, particularly with pronounced and / or long-standing acne inversa. These include:

• bacterial skin inflammation (erysipelas),
• Lymphedema,
• Squamous cell carcinoma,
• Narrowing of the ureter, anus, or rectum.

Concomitant diseases often occur with acne inversa. These comorbidities mainly include diseases from the autoimmunological or autoinflammatory area, in particular:

• chronic inflammatory bowel disease (IBD),
• Diseases of the vertebral joints (spondyloarthropathies),
• Ulcer formation with death of skin (pyoderma gangrenosum).

How is acne inversa diagnosed?

It still takes an average of more than seven years for acne inversa to be correctly diagnosed. In the context of the anamnesis, family predisposition and tobacco consumption in particular are queried. The body mass index is also determined. Diagnosis is primarily made through physical examination. Characteristic skin lesions are found in the typical areas. Fistula sounding may be helpful. Usually a laboratory test (especially blood sedimentation, C-reactive protein) is also carried out. The germs are identified from swabs from the skin surface and from deep tissue areas. Further examinations such as ultrasound or magnetic resonance tomography can determine the depth of the fistula.

How is the treatment carried out?

The disease is difficult to treat. In the best case, drug therapies can alleviate symptoms and lead to symptom-free or at least symptom-free phases. A causal therapy is only possible through surgical interventions in which diseased skin areas are removed.

Medication

A distinction is made between topical, ie locally applicable, and systemic therapies (for swallowing or injection).

Topical therapies:

• Antiseptics: Well-tolerated substances have a certain value in prophylaxis and therapy. In order to achieve a sufficient effect, care must be taken to ensure an appropriate exposure time in an adequate dosage. Polyhexanide, octenidine, PVP iodine, sodium hypochlorite or hypochlorous acid are mainly used.
• Platelet rich fibrin (PRF): This biological tissue made from the body's own blood is enriched with an antibiotic / antiseptic and applied to the parts of the body affected by HS. This supports and accelerates wound healing.
• Manuka honey : Medicinal honey has high antimicrobial activity, has anti-inflammatory effects and promotes the healing of skin lesions.

Systemic therapies

• Antibiotics: These are mostly recommended as first-line therapy for all degrees of acne inversa. Targeted antibiosis against those germs that were isolated from the smears is important. Therapy should take place at an adequate dose for at least ten weeks. You can choose from tetracyclines, clindamycin, rifampicin, moxifloxacin and metronidazole in different combinations.
• Biological agents: The tumor necrosis factor alpha blocker adalimumab is the only biological agent approved for the treatment of moderate to severe acne inversa. The substance available as a solution for injection is mostly used when antibiotics are not sufficiently effective or cannot be tolerated.
• Alternative systemic therapies: Antiandrogens, corticosteroids and acitretin are of relatively minor importance.

surgery

Surgical rehabilitation or removal of affected skin areas is the only option through which the affected areas can be healed over the long term. Acute abscesses are opened surgically and flushed with antibiotics. In chronic acne inversa, permanent healing of fistulous lesions is possible. An indication for surgery is the existence of a chronic fistula, which occurs again at least once after it has subsided. The prerequisite for a lasting success of the operation and the avoidance of recurrences is the removal of the inflammatory or fistulated tissue as completely as possible. A combination of drug therapies and surgery can be useful in individual cases.

Whom can I ask?

In the first instance, the following bodies are responsible for clarifying acne inversa:

• General Practitioner,
• Specialist in dermatology and venereology.

HS is a dermatosurgical disease that should be treated at a specialized center. Early referral saves patients from a long path of suffering and significantly improves their quality of life.

Basically, when caring for patients with acne inversa, greater attention should be paid to accompanying diseases. Against this background, interdisciplinary cooperation in the following disciplines is necessary for optimal treatment:

• Dermatology,
• Gastroenterology,
• Gynecology,
• Urology,
• Surgery.

How are the costs going to be covered?

The costs for diagnosis, drug and surgical therapy are usually covered by the health insurance providers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

Note Purely cosmetic treatments are to be paid for by the patient themselves.

When hospitalization is required

Hospitalization may sometimes be required for treatment. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription by the general practitioner or specialist.

For more information, see What does a hospital stay cost?