Although most forms of acne are rather mild and aren’t medically serious, there are also a few rare forms of acne that can have an extreme psychological impact as well as even be physically disfiguring.
Cystic acne, acne conglobata, and acne fulminans are all relatively well known and documented within the medical community, however there is a rare condition known as acne inversa about which little is known, and it is often misdiagnosed.
What Is Acne Inversa?
Surprisingly, acne inversa is not actually a form of acne at all, but rather it is one of many names given to a skin disease primarily known as hidradenitis suppurativa (HS for short).
Hidradenitis suppurativa is characterized by the formation of chronic abscesses, cysts (epidermoid, sebaceaous, and pilonidal), and multilocalised infections forming in what are known as “inverse” areas of the body i.e., areas where two body parts come together and there is skin-to-skin contact such as the armpits, groin, and breasts.
These cysts and abscesses can range in size from as small as a pea, to as large as a baseball in some cases. They are usually extremely painful to the touch, and can persist for years with occasional periods of severe inflammation.
Acne inversa is not contagious, and shows itself progressively through 3 stages of development.
Other Names For Acne Inversa
- Hidradenitis Suppurativa (HS)
- Hidradenitis Supportiva (Common misspelling)
- Acne Inversa (AI)
- Apocrine Acne (Out-dated, no longer used)
- Apocrinitis (Out-dated, no longer used)
- Verneuil’s disease
- Velpeau’s disease
- Fox-den disease (Not used in medical literature)
- Pyodermia sinifica fistulans (Archaic, no longer used)
3 Stages of Acne Inversa
The following are the 3 “Hurley” stages of hidradenitis suppurativa, as defined by Wikipedia.
- Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)
- Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammation restrict movement and may require minor surgery such as incision and drainage.)
- Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection. Obviously, patients at this stage may be unable to function.)
Acne Inversa Causes
Since hidradenitis suppurativa is poorly studied, the exact causes of the disorder remain unknown and there is some disagreement within the medical community. Although many experts disagree with one another, here are some of the more widely accepted causes and triggers of acne inversa.
- Genetics – There appears to be a genetic predisposition, especially amongst those with Sephardic Jewish, Italian, Greek, Middle Eastern and Northern African ancestry.
- Androgen Dysfunction – Excessive amounts of sex hormones such as androgens are believed to trigger HS.
- Plugged Apocrine Glands or Hair Follicles – Apocrine glands are a certain type of sweat gland found in the inverse areas of the body.
Acne Inversa Treatment
Due to the poor nature of medical literature and study for this disorder, the effectiveness of various treatment options is poorly understood and nearly a quarter of all patients find that nothing relieves their symptoms.
Still, by working with a doctor or dermatologist on an individual basis it is usually possible to find some acne inversa relief, even if it is only partial or temporary.
Below are some of the more common treatment options for hidradenitis suppurativa.
- Weight loss in overweight or obese patients has been shown to improve symptoms.
- Avoiding tight clothing or clothing that rubs against the skin and causes irritation.
- Dietary changes, such as eliminating foods high in refined carbohydrates.
- Applying ice to the cysts to reduce inflammation.
- Antibiotics can be taken orally to reduce inflammation, but do little to actually treat the infections.
- Corticosteroid injections
- Vitamin A Supplementation
- Topical clindamycin
- Anti-androgen therapy
- Zinc gluconate taken orally at doses of 30 mg, 3 times daily.
