Acne Inversa

"Acne inversa, also known as hidradenitis suppurativa, is a serious chronic skin disease that affects 1-4% of the population. It particularly affects skin folds such as the armpit, groin and also around the anus. Furuncle-like inflammations occur, which are painful and eventually melt and scar.Although acne inversa is an incurable skin disease, the symptoms can be brought under control with various therapies. In addition to classic acne inversa therapy, we offer very helpful complementary therapies."

Dr. med. (I) Ikonija Koceva, Physician
Dr. med. (I) Ikonija Koceva, Physician
Symptoms

Acne Inversa Symptoms

The symptoms of acne inversa may appear during puberty or even later, with women and men between 20 and 30 years of age being most often affected by this skin disease. The inflammation spreads in the skin, sebaceous and sweat glands and leads to purulent, painful abscesses and fistula formations. Often these infections leave scars on the skin, especially in the so-called intertrigines, the folds of skin such as the armpits, groin and also around the anus.

The diagnosis of acne inversa, also known as hidradenitis suppurativa or Verneuil's disease, is based on the classification into three degrees of severity:

Hurley Grade I

  • Single or many painful abscesses without scarring.

Hurley Grade II

  • Repeated painful abscesses with strand formation and scarring.

Hurley Grade III

  • Plate-like scarring, many abscesses and strands, painful restriction of motion.
Causes

Acne Inversa Causes

The exact cause of acne inversa is not known, but there are some factors that may contribute to the development of the disease.

Often follicular hyperkeratosis can be detected, i.e. excessive keratinization of the hair sheath cells. This causes the hair to grow into the skin and bacteria to accumulate in the closed cavity, leading to the destruction of the hair follicle. As a result, the sweat glands become inflamed.

The disease runs in families, which means it has a hereditary component. About 90% of sufferers are smokers and most patients are overweight and sweat heavily.

Tight-fitting clothes worsen the situation, and regular shaving of underarm and intimate hair is also cited as a cause.

Treatment

Acne Inversa Treatment

The treatment of acne inversa includes classical therapy methods as well as additional treatment methods that we offer in our clinic:

Classic treatments

In addition to disinfecting washing preparations and creams, short-term antibiotic administration and, if necessary, long-term biologicals, surgical procedures are also used for the treatment of acne inversa. In these, individual nodules and fistula tracts can be excised, or in severe forms of the disease, large-scale surgical removal of the diseased areas may be necessary. For the opening of fistula tracts we use ablative lasers.

Laser and light treatments

  • In the early phases of the disease, the thorough Laser epilation in the diseased area plays an important role. Consistently remove the hair in the affected area and thus avoid shaving, which could lead to bacterial infections or ingrown hairs.
  • With Kleresca in particular, inflammation can be relieved and scarring processes alleviated.

Injections

The active ingredient Botulinum toxin is also used to treat hidradenitis suppurativa. It specifically blocks the nerve impulses sent to the sweat glands. After the application of botulinum toxin, sweating can be "exhibited" locally for up to 6 months. This helps to dry out the affected areas, resulting in less inflammation.

In our clinic, we attach great importance to comprehensive consultation and support you with professional care products that are specially tailored to the needs of patients with hidradenitis suppurativa. By combining classic and innovative treatment methods, we aim to positively influence the course of this chronic skin disease and improve the quality of life of those affected.

Frequently asked questions

Acne Inversa Frequently Asked Questions

What treatments are most effective for acne inversa and how can I choose the right treatment for my skin type and condition?

Acne inversa is a serious chronic inflammatory disease and you belong in the hands of a specialist. It is not you who should choose your treatment, but you need the advice of experienced specialists. At Hautwerk, we combine different treatment approaches with the goal of achieving the best possible disease control.

How can professional acne inversa treatment improve the appearance of my skin?

It depends on the stage of the disease at which they visit the doctor. If scarring and fistula tracts have already developed, it will not be possible to dispense with surgical measures. If we assume the best case and you come in time, the inflammations should be stopped with all measures. In our opinion, this includes laser hair removal in the affected area, because in acne inversa it is the hair organ that becomes inflamed. Once the hair is removed, no more hair can grow in and there is no need for irritating shaves. Excessive sweating can be reduced by appropriate breathable clothing, weight reduction but also by injections with botulinum toxin (known as Botox). Depending on the extent of the inflammation, appropriate medication should also be used, partly locally, partly in tablet form or injection.

What can I expect during treatment for acne inversa?

The goal of treatment is to control inflammation and heal the inflamed nodules. When this is achieved, scarring can also be improved by laser ablation or fractional lasers.

What is the recovery time for acne inversa treatment and how long does it take before I see results?

If the clinical picture is very advanced, large-scale surgical removals must take place. These take months to heal. If you are still in the early stages, you may notice improvements after laser epilation, for example.

What kind of aftercare is required after acne inversa treatment?

It completely depends on the type of treatment. After laser epilation there is no need for post-treatment, after surgical procedures there is a need for daily wound care.

Can acne inversa be prevented, and what steps can I take to reduce my risk of developing the disease?

To counteract hidradenitis suppurative in everyday life, simple methods such as wearing wide and breathable clothes, regular and disinfecting washing of the affected areas and avoiding deodorant rollers or deodorant sticks (use solutions or sprays instead) help. In addition, one should stop smoking, not shave the intimate area and axillae, and always dry the armpits well.
Further information

Further information

Publications
Hidradenitis suppurativa: Adjuvant therapy with laser and botulinum toxin A.
Nienstedt, R./Karwath, M./Navarini, A./Rümmelein, B. / Leading Opinions Dermatology & Plastic Surgery 2021; 3: 6-8.
Publications
Fluorescent light energy: A new therapeutic approach to effectively treating acne conglobata and hidradenitis suppurativa.
Koceva, I./Rümmelein, B./Gerber, P.A./Edge, D./Engelbrecht Nielsen, M.C. / Wiley Online Library, August 2019.

Further information

Publications
Hidradenitis suppurativa: Adjuvant therapy with laser and botulinum toxin A.
Nienstedt, R./Karwath, M./Navarini, A./Rümmelein, B. / Leading Opinions Dermatology & Plastic Surgery 2021; 3: 6-8.
Publications
Fluorescent light energy: A new therapeutic approach to effectively treating acne conglobata and hidradenitis suppurativa.
Koceva, I./Rümmelein, B./Gerber, P.A./Edge, D./Engelbrecht Nielsen, M.C. / Wiley Online Library, August 2019.