Acne Inversa: When Acne Goes Hardcore

March, 2006
Fashion Monitor Toronto
© 2004 VG Systems Consulting Inc
 

Acne inversa (alias hidradenitis suppurativa) is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring.

Once considered to be a disease of the apocrine glands, acne inversa is actually a defect of follicular epithelium. Thus, the term hidradenitis suppurativa is a misnomer and should be abandoned.

Acne inversa is a non-contagious, recurrent disease affecting inverse areas of the body (those places where there is skin-to-skin contact - armpits, groin, breasts, etc.), and where apocrine glands and hair follicles are found. It typically manifests itself as a progression from single boil-like, pus-filled abscesses, or hard sebaceous lumps, to painful, deep-seated, often inflamed clusters of lesions with chronic seepage (suppuration - hence the name) involving significant scarring.

Acne inversa is not caused by such factors as hyperandrogenism, obesity, smoking and chemical irritants. Bacterial involvement is not a primary event in acne inversa, but is secondary to the disease process.

Potential complications of acne inversa include dermal contraction, local or systemic infection due to the spread of microorganisms, systemic amyloidosis, arthropathy, and squamous cell carcinoma.

As spontaneous resolution of acne inversa is rare and progressive disability is the rule, early definitive surgical intervention is advisable. The surgical procedure of choice in most cases is wide local excision and healing by secondary intention.

Pharmacotherapeutic drugs, including synthetic retinoids and antiandrogens, do not prevent progression of acne inversa.

Abscesses may be as large as baseballs in some people, are extremely painful to the touch and may persist for years with occasional to frequent periods of inflammation, culminating in drainage, often leaving open wounds that will not heal. These "flare-ups" are often triggered by stress, hormonal changes, or humid heat. Drainage of the lumps provides some relief from severe, often debilitating, pressure pain; however, pain occurs 24 hours a day, 7 days a week for acne inversa sufferers during flare-ups, and is difficult to manage.

Persistent lesions may lead to the formation of sinus tracts, or tunnels connecting the abscesses under the skin. At this stage, complete healing is usually not possible, and progression of the disease in the area is inevitable. Occurrences of bacterial infections and cellulitis (deep tissue inflammation) are likely at these sites.

Because of the drainage which may have a foul odor, fever and fatigue caused by acute inflammation and the physical restrictions caused by pain and skin deformation, people often cannot work, drive, exercise or even perform day-to-day tasks, and are ashamed to go out in public. Acne inversa sufferers may go through severe bouts of depression, avoid public and inter-personal contact, and become sedentary and often overweight.

Acne inversa typically goes undiagnosed for years because patients are ashamed to speak with anyone. When they do see a doctor, the disease is frequently misdiagnosed. Only relatively few physicians are able to recognize it and even when they do, suggested treatments are often ineffective, temporary and sometimes even harmful. There is no known cure or any consistently effective treatment for acne inverse. What works for one person may not work for another. In advanced, chronic cases, surgery is often the choice, but recurrences of acne inversa are not uncommon.

Although the cause of acne inversa is unknown, very little research is being conducted on acne inversa, with Europe at the forefront. There is essentially no research being performed in the United States. Historically, acne inversa has been considered a rare disorder, because it is difficult to accurately estimate the number of acne inversa victims; they conceal their condition, even from friends and close relatives. Estimates, however, indicate at least 1 million - potentially up to 12 million - acne inversa , or Hidradenitis Suppurativa sufferers in the United States alone!

Based on article abstract by Jansen I, Altmeyer P, Piewig G., Department of Dermatology, Ruhr-University Bochum, Germany and web source www.hs-usa.org