Acne inversa and other forms of acne

Acne inversa is a painful, chronic inflammatory skin disease that mainly affects the armpits, groin and pubic and anal areas. The condition often begins with inflammation of the hair roots and then spreads in the form of recurrent inflammation and abscesses. An estimated 1% of the population is affected. Often the disease is diagnosed too late and at an advanced stage. Out of fear and shame, sufferers often withdraw, which can disrupt professional careers, personal and social relationships, and lead to depression.

How does acne inversa develop?

The causes are not exactly known, but the primary event is keratinization disorder or also called hyperkeratosis, which results in follicular occlusion. Sebum accumulation and destruction of the sebaceous glands and inflammation of the hair follicles occur. Immigration of bacteria is one of the secondary events. With progressive inflammation and sebaceous accumulation, rupture of the follicles often occurs, which can lead to fistula formation. These events can be caused by a hereditary predisposition, there are also other reinforcing factors that can affect the clinical picture.

Which factors have an influence on acne inversa?

The cause of acne inversa has not been conclusively clarified. However, it is known that there are reinforcing factors that can trigger inflammation and/or intensify the symptoms: Negative stress, skin irritation from clothing, and sweat and bacteria entering the skin from minimal injuries (micro-injuries), such as shaving, are among these factors. There is also evidence of a hormonal role, which can often lead to episodes of disease during menstruation. Smoking and obesity also have a negative influence on the disease.

How does the disease progress?

Depending on the severity level, divided into Hurley grade I to III, affected individuals suffer from recurrent festering, oozing sores. Patients classified as Hurley severity level I usually have isolated inflammatory nodules or abscesses in surrounding healthy tissue. In severity level II, progressive demarcated inflammation with scarring and fistula formation are described. In severity level III, there are extensive, interconnected abscesses and fistula tracts.

What are the treatment options?

  • Hurley I: Local or systemic antibiotic administration, surgical removal of individual lesions injuries/sites if necessary.
  • Hurley II: Systemic antibiotic administration, antibody administration, surgical removal of individual lesions, laser ablation of superficial tissue layers if necessary.
  • Hurley III: Systemic antibiotic administration, antibody administration, radical surgical removal of affected tissue.

For wound treatment after surgery for Hurley grade II-III, it is recommended not to sew up the wound, but to let it heal "open". Appropriate dressings and, if necessary, negative pressure wound therapy (NPWT) are used to cover the "open" wound.

To minimize the risk of restricted movement due to scar adhesions, stretching exercises should be performed, if necessary under physiotherapeutic guidance.

To avoid inflammation, prevent recurrence (recurrence of lesions in the surgical area), slow down the course of the disease and treat scars, LAight therapy, as a gentle, non-invasive combination therapy of light and radio frequencies, can be used in a supportive manner in all degrees of Ai.

Classification of severity according to Hurley:

Can the course of the disease be slowed and symptoms reduced?

Since the cause of acne inversa is unknown, therapies aim at symptom control. Non-permanent methods, such as antibiotics, can be used for relapse control, or therapies can be applied that additionally reduce the formation of new inflammatory lesions. One such therapy is the special combination of light and radiofrequency (LAight therapy), which is applied locally to the affected areas. Sebum production is reduced and abscesses are stimulated to mature by LAight therapy, which helps to drain the abscesses and thus relieve pressure and pain. Blood circulation is stimulated, as is metabolism, and inflammation is reduced. Because bacteria on the skin surface are destroyed at the same time and hyperkeratosis (cornification disorder) is reduced, fewer inclusions occur as a result. Therefore a great improvement in the quality of life of those affected can be achieved.

Actively addressing the factors (see above) that can aggravate the clinical picture can also positively influence the course of the disease. This is usually associated with a change in lifestyle.

At the WCC-WoundCareCenters, we offer LAight therapy as well as care for post-op wounds and open lesions. Other therapy options are available in collaboration with specialists. We always take a holistic view of the patient and can also address any aggravating factors of acne inversa.

Price overview LAight therapy (PDF 322 KB)

More informations

Other forms of acne

Acne is an inflammatory disease of the sebaceous glands and hair follicles. It can be divided into different forms. These include acne vulgaris, or common acne, and also acne conglobata, a very pronounced form of common acne.

Clinically, acne usually presents with nodular thickenings in the skin and pustules. It mainly affects the face and, less frequently, the décolleté and back.

Acne is the most common skin disease worldwide. 70 to 95% of all adolescents between the ages of 15 and 18 get acne. After puberty, there is usually a spontaneous regression. In 2 to 7% of those affected, considerable scarring remains. In more severe forms, sufferers often experience a significant reduction in quality of life, due to anxiety, depression and social stigma.

Androgens (male sex hormones), skin lipids and endogenous messenger substances (neuropeptides) appear to be involved in the development of acne.

Influencing risk factors:

  • Genetic factors
  • Irregular menstrual cycle or hormonal fluctuations
  • Pregnancy
  • Diet
  • Environmental factors, e.g. UV radiation
  • Medication
  • Microorganisms

Course forms of acne:

Acne vulgaris is an inflammatory disease of the sebaceous glands and hair follicles.
Acne conglobata is a severe form of progression, which has painful nodules and fistula knives on the face and upper body and is psychologically very stressful.
Acne comedonica is characterized by blackheads without inflammation; closed comedones (sebaceous inclusions) are often found on the cheeks, forehead, nose and chin.
Acne papulopustulosa is the most common form and is characterized by inflamed blackheads with formation of nodules and pustules. Acne papulopustulosa is a progressive form of acne vulgaris, which is characterized by secondary inflammation of comedones.

In mild and moderate severity, acne can be treated by local therapies with anti-inflammatory, desquamating, blackhead-dissolving agents. In severe forms, this is usually not sufficient. For acne vulgaris and acne conglobata, physical LAight therapy is a gentle option. Systemic antibiotic or retinoid therapies that reduce sebum production may also be considered.

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