Acne inversa

What is acne inversa?

Acne inversa (Acne inversa) is an inflammatory skin disease that primarily affects the regions where skin folds tend to form. These are, for example, the armpits and the genital region. It comes here to extensive inflammation, pus accumulation, abscesses and conspicuous scars. In addition, passages may form from the skin to other organs (fistulas). Left untreated, the inversa acne continues to spread and become chronic. This may ultimately affect the entire skin and subcutaneous fatty tissue of the affected regions.

The serious disease is still poorly known because very few people suffer from it. Women are more likely to get acne inversa than men. In most cases, the disease occurs for the first time after puberty and before the age of 30 years.

by the way: In many cases, acne inversa is associated with the more common acne vulgaris.

Acne inversa: symptoms

In the case of acne inversa, initially only the hair roots and the associated sebaceous and sweat glands become inflamed on the affected skin areas. It is formed palpable knots and thickeningsthat look like enlarged blackheads. The inflammation-induced backflow of sebum and sweat secretions may over time lead to the formation of pus (Abscesses) in the area of ​​the sweat glands. The glandular tissue is destroyed. Branched ducts can form into deeper tissue layers or to the body surface (fistulas). The accumulations of pus can spontaneously deflate and release pus, sebum or a bad-smelling secretion. After a few years, the affected regions are mostly affected by a variety of scar former inflammatory foci.

These diseases of acne inversa affect the following regions of the body:

• armpits
• Afford
• genital region
• tummy tucks
• Wrinkles under the female breast

Acne inversa: effects and consequences

Due to the physical symptoms, acne inversa patients are severely impaired in their quality of life. In addition, the disease may have further effects that adversely affect the everyday life, professional and relationship life of those affected. This includes:

• Pain
• sleep disorders
• movement restrictions
• Obesity (obesity)
• feeling of disgust
• Disfigurement problem associated with shame
• Wet feeling, soiling of clothing (with pus emptying)
• Soft tissue swelling under the skin due to a disorder in the lymphatic system (lymphedema)
• limited efficiency
• Impaired sex life
• Fear of secondary diseases: anemia, development of tumor in the anus and genital area
• Fear of stress in the family / social environment
• Fear of unemployment / financial problems
• Fear of genetic stress / heredity

Acne inversa: causes and risk factors

The exact causes of acne inversa are still unknown. Experts, however, suspect that Disorders of the immune system and hormonal influences could play a role in the development of severe skin disease. In addition, some people apparently have one hereditary predisposition for acne inversa.

It is certain that certain factors can trigger or intensify the skin disease. To this trigger factors counting:

• Smoking (very important trigger factor for acne inversa!)
• strong overweight (obesity)
• Stress and mental stress
• sweat
• mechanical irritation (such as tight clothing)
• Removal of body hair (shaving)
• bacterial colonization of hair follicles (especially with Staphylococcus aureus)

In addition, there is often a link between acne inversa and some other diseases such as the chronic inflammatory bowel disease ulcerative colitis and Crohn’s disease.

Acne inversa: examinations and diagnosis

Until acne inversa is diagnosed, it often takes years. This is due to the fact that many sufferers from shame feel late to go to the doctor. In addition, the disease is so rare that many physicians have little experience with it and therefore do not immediately make the right diagnosis.

To clarify the skin changes, the doctor is first talking to the patient To raise medical history (Anamnese). Among other things, he lets himself be described in detail about all symptoms and complaints and asks how long they have lasted. He also inquires about important risk factors for acne inversa, such as whether other family members are suffering from the skin disease and whether the patient smokes. The doctor will also measure the weight and height of the patient to determine their body mass index (BMI). In addition to tobacco consumption, being overweight is another important trigger factor for acne inversa.

After that follows one physical examination, For example, the doctor carefully examines the lesions and scans the tissue. He can examine any fistulas with the help of a probe. Usually the doctor also takes blood samplesto determine inflammatory parameters such as blood sedimentation and C-reactive protein.

Also informative Smears of the skin surface and Samples from deeper tissue layers be on the pathologically changed skin areas. In it existing germs can be detected in the laboratory.

With help Imaging process the doctor can determine the depth of the disease or fistula tracts. For example, ultrasound examination and magnetic resonance imaging (magnetic resonance imaging, MRI) are used.

Note: In his investigations, the physician must rule out other conditions with symptoms similar to acne inversa. These include, for example, a recurring inflammation of the hair folliculitis, the deep, purulent inflammation of a single hair ball (boil) or several neighboring hair calves (carbuncle) and skin tuberculosis.

Acne inversa: treatment

The treatment of acne inversa is difficult and depends on the stage (severity) of the disease. Sometimes, medications can relieve symptoms and provide the patient with symptom-free or at-least-symptom-free phases. Often, surgical procedures can not be avoided. In general, the acne inversa treatment takes place in medical centers that specialize in skin diseases. These are in Germany, for example, all major dermatological centers and centers of plastic surgery.

Medicines for acne inversa

For the local wound treatment will be antiseptic (antimicrobial) preparations in the form of solutions or ointments (e.g., polyhexanide, octenidine or PVP-iodine).

In addition, the doctor prescribes often antibioticsto control bacterial infections that can significantly affect the course of acne inversa. The choice of active ingredients depends on the germs that are detected in the smears and tissue samples. For example, clindamycin, rifampicin and tetracyclines are available. They are applied locally or in tablet form.

Heavier cases of acne inversa are sometimes associated with the so-called TNF inhibitors Adalimumab (TNF = Tumor Necrosis Factor). It is a biotechnologically produced monoclonal antibody that can slow 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 become uncommon antiandrogens prescribed. They have an inhibiting effect on the male sex hormones, which are also produced in the female body in small quantities. This can have a positive effect on the course of the disease.

Rarely, in the treatment of acne inversa other medications are used, such as corticosteroids (“cortisone”) or acitretin.

Surgical treatment

In many cases acne inversa requires surgical intervention. So the doctor often has Open inflammatory foci: The purulent bumps (abscesses) are cut open, deflated and rinsed with antibiotics.

For the most part, advanced acne inversa can only be cured by the surgical removal of diseased skin, Depending on the size of the defect and any existing wound healing disorders, three options for wound treatment are possible:

1. secondary cure: Here, the wound edges are sutured together, and it forms a scar at the interface. The secondary healing is especially suitable for smaller areas of skin.
2. NahlappenplastikIn a Nahlappenplastik healthy skin is moved from the environment to close the wound. The surgeon must make sure that the tension that arises in the skin, the mobility is not restricted.
3. Split skin transplantation: In split-thickness skin grafting, for example, healthy skin is removed from the back of the head or thigh and placed in the wound. The site from which the skin was taken heals on its own like a bruise.

Other therapeutic measures

(Still) become rare laser therapies used in acne inversa, for example, to remove diseased tissue or as radiation therapy.

No matter how acne inversa is treated – the therapy also depends on whether it succeeds To avoid trigger factors, Above all, patients should not smoke and avoid or reduce excess weight.

Acne inversa: prognosis

Left untreated, acne inversa can develop into a chronic condition associated with severe pain and a significant decline in quality of life. Many sufferers withdraw from social life, and some even develop depression. That is why it is very important to suspect Acne inversa To be examined and treated early by an experienced dermatologist.