The acne inversa (Hidradenitis suppurativa) is a skin disease that occurs mainly in adults. The hair follicles usually ignite in the armpit and pubic region and cause painful knots. Acne inversa is a great psychological burden for many sufferers.
The acne inversa is an inflammation in the hair roots of the “thick hair” as underarm or pubic hair (terminal hair follicle). Doctors also speak of a hidradenitis suppurativa. It occurs mainly in the area of skin folds – ie in the armpits, the groins, the abdominal folds and under the female breast.
Also in the area of the perineum, the anus and the buttock fold (perianal area), acne inversa often shows the typical nodular inflammations. These are usually painful and develop in the course of pus tears (abscesses) and fistulas under the skin.
Acne inversa has external and mental consequences
Shame and pain can severely affect those affected physically and mentally with an acne inversa. Often the disease is not recognized and treated as such for a long time. The acne inversa is not so rare: Various studies indicate that one in four people are affected by one hundred people. It usually begins after puberty and most often develops between the ages of 20 and 30 years.
In women, the painful inflammations usually occur on the armpit and groin, while in men especially the area of the dam is affected. Acne inversa is a chronic skin disease that spreads as it progresses into the subcutaneous tissue, causing hardening and scarring. The disease can persist into old age.
Causes and risk factors
Trapped bacteria ensure that the hair root and its associated sebaceous glands become inflamed, creating a painful knot under the skin. As the process progresses, the affected hair follicles often break and the surrounding tissue becomes inflamed.
Numerous risk factors for acne inversa
In the process of inflammation, acne inversa can cause various bacteria; Staphylococcus aureus is particularly common. In addition, some risk factors are known that favor the skin disease. This includes:
- Smoke
- overweight
- severe sweating ( hyperhidrosis )
- mechanical skin irritation (eg wet shaving or tight clothing)
- hereditary predisposition
More than 90 percent of those affected are smokers – thus nicotine consumption in acne inversa is one of the most important causes. Medicines suspect the effect, among other things, that nicotine in individual bacteria such as Staphylococcus aureus growth-promoting effect. Probably there is also a hereditary predisposition, which favors the acne inversa together with other causes. About one third of those affected have more family members.
Typical symptoms of acne inversa
The acne inversa shows on the skin through symptoms such as large nodes that flow together in beaded strands. Pressure on the affected skin may result in the discharge of a malodorous secretion of sebum and pus. The patients complain of severe pain. Over time, scars form on the previously inflamed areas.
The stages of acne inversa
Dermatologists classify inversa acne according to their symptoms in three stages:
- Stage 1: Single abscesses without scarring
- Stage 2: Recurrent abscesses with single scar strands
- Stage 3: Extensive involvement with many scar strands and painful movement restrictions
Certain movements such as walking and stretching can be very painful for acne inversa. When the symptoms concern the area of the anus, perineum and gluteal fold, the patients have particularly unpleasant pain when sitting. Fever rarely occurs.
Depression due to visible acne-inversa symptoms
In severe cases, those affected by other people, because they are ashamed of the ugly and often malodorous skin change very much. Depression and alcohol abuse are relatively common in people with severe acne inversa.
That’s how the doctor diagnoses
With acne inversa, it can sometimes take a while to make the right diagnosis, as it can look quite different and is easily confused with other skin conditions – such as recurrent sweat gland abscesses or coccyx fistulas.
In addition to the mere examination of the skin, therefore, a detailed discussion about the course of the disease and the accompanying circumstances is important. Information on smoking habits, pre-existing conditions and other family acne inversa cases makes it easier for the doctor to make the right diagnosis.
The doctor looks at the lesions and carefully scans them carefully. A blood test is usually only necessary if the inflammation has already spread very far. In case of suspected acne inversa, the doctor may take a small tissue sample ( biopsy ) to confirm the diagnosis with a histological examination.
Imaging procedures for diagnosis
With an ultrasound examination (ultrasound) or a magnetic resonance tomography (MRI) can be – often supported by a contrast agent – represent the fistula tracts. This allows the doctor to check how deep it has penetrated the tissue in advanced acne inversa.
Therapy: What helps with acne inversa?
The therapy depends on the severity of the disease. The treatment options range from creams to tablets to surgery.
If there are only isolated nodules without deep fistulas and scars, antibiotic ointments (such as with clindamycin) may be helpful, sometimes in combination with horn-releasing peels (for example with resorcinol).
Therapy with medication
Some patients with acne inversa respond well to oral antibiotics (for example, clindamycin and rifampicin). In addition, a hormonal antiandrogenic therapy – the ” pill ” – can be helpful in women in order to get a grip on the skin problems. Generally speaking, inversa acne does not respond to this treatment as well as many other forms of acne .
Research is currently being conducted into the effect of so-called biologics (for example, infliximab, adalimumab) in acne-inversa treatment. These medicines are commonly used to treat autoimmune diseases such as psoriasis and rheumatoid arthritis. A cure is so far not possible with these relatively expensive and expensive therapy.
Often an operation is necessary
In advanced acne inversa, the only effective treatment is usually surgery. The doctor removes the entire inflamed area with a scalpel or laser. If diseased tissue remains on the body, relapse almost always occurs. The “holes” in the skin resulting from the operation are closed by the doctor either with skin from the immediate environment or the wound healed openly. Then, slowly, from the inside out, a scar forms. Another way to treat acne inversa is, for example, from the thigh healthy skin to the open place to put (flap plastic).
Innovations in the treatment of acne inversa
Since January 25, 2017, the lAight ® Therapy of the Wiesbaden-based company LENICURA has approved a device-based, non-invasive, low-side-dose treatment method for all severity grades and is currently available at 15 locations in Germany. The clinical NICE study of the Mainz University Medical Center (47 participants) is the first study to demonstrate the efficacy of radiation for a majority of patients.
Forecast and history
With the pain and scars often increases the psychological burden of the acne inversa for those affected. Many retreat, avoid unnecessary movements and “console themselves” with food, cigarettes and / or alcohol – a vicious circle, as overweight and nicotine in acne inversa affect the course unfavorably.
Complications in acne-inversa course
In the case of acne inversa, various further complications are possible during the course of the disease:
- Erysipelas (dermatitis caused by certain bacteria, so-called streptococci)
- Phlegmon (overarching, aggressive tissue inflammation)
- Lymphedema (swelling caused by accumulated lymph, often in the genital area)
- Sepsis (“blood poisoning”)
If the inflammation remains untreated for years, a certain skin cancer (squamous cell carcinoma) may develop – albeit very rarely – in the affected cells . Finally, it may also be that the fistulas on the buttocks spread to the area of the rectum and to the ureter. It is therefore all the more important to consult a doctor early in case of an acne inversa in order to avert a difficult course.
So prevent the acne inversa
The acne inversa can be quite well prevent, even if there is a genetic predisposition to the disease.
Today, we know that various factors have a major impact on the disease – most of which you can influence yourself. The following tips can help prevent acne inversa:
Minimize risk
- If you are a smoker, reduce your nicotine consumption as much as possible. Ask your doctor or a smoker advice for valuable tips on stopping smoking .
- If you are overweight, try to reduce the excess pounds with a balanced diet and regular exercise.
- Avoid tight-fitting and abrasive clothing – especially if you sweat slightly.
- If you are prone to skin inflammation, nodules and ingrown hairs, you should not shave the corresponding areas wet or just gently (at once with the stroke) wet.
- Under the armpits, use a mild deodorant that does not irritate the skin unnecessarily.
Healthy lifestyle improves the course
With these tips, you can not only prevent acne inversa, but also positively influence the course of an existing skin disease. Experts advise to quit smoking, especially at every stage of inversa acne.