Acne inversa is distributed worldwide and affects both the female and the male gender. In men more often than women, this skin disease occurs in the anal area, but also occurs in other parts of the body. The disease can manifest from puberty to old age. A non-representative survey among patients by the German interest group Acne inversa eV found that the disease usually breaks out until the age of 30 years.
What does acne inversa mean?
The forms of expression of "acne" (Greek acme (tip), lat. Acne, precise terminology) are chronic skin diseases associated with pimples, abscesses, fistulas and scarring.
"Inversa" means "the other way round" because contrary to the "youth disease" known to many people, the inversa acne does not occur in the face, but almost exclusively in the anal, genital, groin and armpit area.
Synonymous with this disease, the term Hidradenitis suppurativa (sweat gland abscess) has been established. However, this is misleading, as acne inversa is primarily not an inflammation of the sweat, but of the sebaceous glands.
When do we speak of acne inversa?
The disease is divided into three stages, the so-called "Hurley Stages". They allow an assessment of the current severity and progression of acne inversa:
- In stage I, slight changes in the skin are noted: the occasionally occurring, typical black dots (comedones) grow into larger protrusions (giant comedones). If bacteria become grafted on, pus capsules, so-called abscesses, develop. These are warm, red and painful. If one expresses abscesses, pus, tallow and a foul-smelling liquid empties.
- In stage II abscesses form more frequently and in several places, but have no connection to each other. Fistulas and scarring can also occur.
- In the last stage III, the affected body regions are affected over a large area, through the many abscesses it comes to scarring. The inflamed areas are connected by passages under the skin, so-called "fistulas" with each other and lead again and again to abscesses.
In the first stage, the acne inversa can be confused with the acne conglobata. In contrast to the special form of acne inversa, this acne form is one of the "common" acne forms (acne vulgaris). This also causes inflammation, pimples, abscesses and fistulas on the face as well as on the back, arms and legs. The Conglobata form is a severe condition with the formation of larger, deep-reaching nodes and multiple melting abscesses.
Who treats acne inversa?
If you suspect that you may be suffering from acne inversa, you should first have your family doctor examine you. He can then refer you to a specialist in dermatology, a dermatologist.
What helps against acne inversa?
Unfortunately, there is no therapy that leads to a complete cure. However, the symptoms can be alleviated by different measures.
First, known risk factors should be eliminated. For example, smoking is one of the most important factors in acne inversa, as nicotine promotes dermal inflammation and hinders healing. Obesity is also a significant risk factor.
Various ointments and solutions for application to the inflamed areas lead to healing. They are alcohol or ammonium-containing and prevent colonization with bacteria. If it is too late, antibiotic creams, such as clindamycin, can be applied.
There are also herbal remedies on the market. If you have any questions about homeopathy for acne inversa, it is best to contact your doctor.
Depending on the stage, additional medication or even surgery will be needed.
Stage-dependent therapy of acne inversa
In stage I, antibiotics are used. Common drugs are clindamycin and rifampicin. These are taken as tablets or injected via the vein and are thus intended to combat the bacterial dermatitis.
Other medications used in acne inversa include immunosuppressants such as the drug infliximab. Immunosuppressants affect protein production at the DNA level and can thus curb the overproduction of skin cells and thus the keratinization and obstruction of the excretory ducts. Depending on the severity of the findings, these preparations are also administered as tablets or via the vein.
In women, antiandrogenic medication can sometimes help. The preparations, for example ethinyl estradiol or cyproterone acetate, reduce the testosterone level, which has a positive effect on the inflammation.
All of these medications are prescription drugs, have numerous side effects and should only be taken after consulting a doctor.
When is an operation necessary?
In stage II and III major skin findings have to be cut out by the dermatologist. Depending on the complexity of the procedure, the operation can be performed in local anesthesia and on an outpatient basis or under general anesthesia followed by hospitalization.
Other forms of treatment for acne inversa
In addition to the conventional technique using a scalpel, laser methods are also used. When which technique applies, depends on the size and depth of the skin findings.
For many skin diseases, light therapy (photodynamic therapy) has a positive effect. However, in the case of acne inversa, the use of experts is not recommended as it has proven to be ineffective.
Also, therapeutic radiation is discouraged due to the side effects of X-rays (radiation dermatoses, tumor development).
lAight ® therapy as an alternative method of treatment
However, an alternative procedure has been approved in Germany since April 2017. The so-called lAight ® therapy uses electromagnetic waves, more precisely a combination of light and radio frequency 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 is applicable to all stages of acne inversa, the effect being more pronounced the sooner the therapy is started. The therapy can also have a positive effect on existing scars.
So far, the technique is used only in special wound centers and medical practices and the costs are borne by the patient himself. If you have any questions about the relatively new procedure, contact your dermatologist.
Is acne inversa contagious?
The acne inversa is not contagious. However, a familial clustering is observed and therefore a genetic component is considered very likely. However, genes are not the sole cause.
Reasons for an acne inversa
The causes of acne inversa have not been definitively clarified. It is assumed that an overproduction of skin, that is, keratinization (hyperkeratosis), is the trigger in the affected regions. The excess skin cells clog the hair channels of the skin, waste materials can no longer be delivered. Inflammation under the skin surface is the result.
This inflammation under the skin creates a permanently recurring (chronic-relapsing) inflammatory disease of the hair roots and sweat glands and surrounding skin layers.
So it is also understandable why armpits and intimate areas are particularly affected - here pronounced body hair and perspiration come together. Add bacteria to the body's own skin flora, the inflammation in many cases even worse.
Another potential trigger for acne inversa may be mechanical irritation, such as rubbing underwear, trousers or bra on the skin.
Diet for acne inversa
There is no direct correlation between dietary habits and acne inversa. However, it is known that obesity has a negative influence on the course of the disease. A healthy and balanced diet is therefore important.
The increased release of insulin also seems to have an influence. This is the case when the blood sugar rises rapidly, so with food with readily available sugar (carbohydrates), for example, very sugary food or white flour.
Also not recommended is very greasy food. This not only leads to weight gain, but the contained omega-6 fatty acids are also suspected to promote inflammation in general.
Acne inversa - what now?
The treatment of inversa acne is difficult and a definitive cure is not possible. Those affected suffer from the effects of inflammation, scarring, cosmetic effects and pain.
Not infrequently, these patients develop depression, are discouraged and depressed in the face of the hopeless prognosis. However, as indicated, there are many ways to treat the individual findings and alleviate symptoms, with the prospect of curbing the disease.