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Acne Inversa: Causes, Symptoms & Treatment
Acne inversa is a chronic inflammatory skin disease causing painful nodules and abscesses in skin folds. Learn about causes, symptoms, and treatment options.
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Acne inversa is a chronic inflammatory skin disease causing painful nodules and abscesses in skin folds. Learn about causes, symptoms, and treatment options.
What is Acne Inversa?
Acne inversa (also known as hidradenitis suppurativa) is a chronic inflammatory skin condition that primarily affects the skin folds of the body. The most commonly involved areas include the armpits, groin, inner thighs, and buttocks. The disease follows a relapsing-remitting course and can cause significant pain, scarring, and a severely reduced quality of life.
Causes and Risk Factors
The exact cause of acne inversa has not yet been fully established. It is believed that blockage of hair follicles combined with an excessive immune response plays a central role in its development. Key risk factors include:
- Genetic predisposition: A family history is commonly observed, and certain gene mutations may be involved.
- Smoking: One of the most significant risk factors, known to worsen the course of the disease.
- Obesity: A high body mass index (BMI) promotes friction and sweating in skin folds.
- Hormonal influences: The condition often develops after puberty and is more common in women than in men.
- Microbiome changes: Alterations in the skin bacterial flora may also contribute to the condition.
Symptoms
The symptoms of acne inversa can vary widely depending on severity. Common signs and symptoms include:
- Painful, deep-seated nodules and abscesses in skin fold areas
- Sinus tract formation (tunnels connecting multiple lesions beneath the skin)
- Discharge of pus and wound secretions from affected areas
- Significant scarring following resolution of inflamed lesions
- Itching, burning, and a sensation of tightness in the affected skin
- Recurrent flare-ups with acute signs of inflammation
Diagnosis
Acne inversa is typically diagnosed clinically, meaning through physical examination. A dermatologist assesses the characteristic location, appearance, and history of the lesions. The Hurley classification system (Stages I to III) is commonly used to grade disease severity:
- Stage I: Single abscesses without sinus tracts or scarring
- Stage II: Recurrent abscesses with sinus tract formation and scarring
- Stage III: Extensive sinus tracts and scarring covering large areas of skin
Blood tests to assess inflammatory markers and skin ultrasound imaging may also be performed as part of the evaluation.
Treatment
Treatment of acne inversa is tailored to disease severity and aims to control inflammation, relieve pain, and prevent complications.
Conservative Treatment
- Antibiotics: Topical agents (e.g., clindamycin) or systemic therapy (e.g., doxycycline, or clindamycin combined with rifampicin) to reduce inflammation
- Retinoids: Vitamin A derivatives such as acitretin may be used in selected cases
- Biologics: Adalimumab (a TNF-alpha inhibitor) is the only biologic approved in Europe specifically for acne inversa and is indicated for moderate to severe disease
- Corticosteroids: Local injections can help to relieve acute inflammatory flares
Surgical Treatment
- Surgical excision: Wide excision of affected skin and subcutaneous tissue in advanced disease stages
- Laser therapy: CO2 laser or Nd:YAG laser for the treatment of individual lesions
- Incision and drainage: Used as an emergency measure for acutely painful abscesses
General Measures
- Smoking cessation, as smoking significantly worsens the course of disease
- Weight reduction in overweight patients
- Wearing soft, loose-fitting clothing to minimize skin friction
- Gentle skin care using non-irritating products
References
- Zouboulis CC, et al. - European S1 guideline for the treatment of hidradenitis suppurativa / acne inversa. Journal of the European Academy of Dermatology and Venereology, 2015.
- Jemec GBE - Hidradenitis Suppurativa. New England Journal of Medicine, 2012; 366(2):158-164.
- Deutsche Dermatologische Gesellschaft (DDG) - Guideline on Hidradenitis suppurativa / Acne inversa, AWMF Register No. 013-035, 2020.
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