Acne inversa L73.2

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Fabian Müller

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

Dissecting terminal hair folliculitis

History
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Plewig and Steger, 1989

Definition
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Probably a special form of acne vulgaris in adulthood, affecting areas rich in apocrine sweat glands and terminal hairs (inverse pattern), with formation of comedones and eminently chronic abscessed fistula ducts (DD: Hidradenitis suppurativa).

Localization
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Perineum, perianal region, scrotal root, buttocks, inner and outer sides of the thighs as well as axilla, upper arm and chest region.

Clinical features
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Multiple, chronically stationary, mostly painful, disseminated, flatly elevated, or clearly raised, blurred, red solid papules, plaques and nodules. Also painful, floating abscesses or deeply sunken, rough scar plates or scar bulges, which can lead to movement restrictions. On close inspection, small sunken comedones are found again and again, which makes it clear that they belong to the acne group.

Therapy
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For less pronounced cases, a complex external, systemic approach is recommended:

  • Retinoids: The effectiveness of retinoids is evaluated differently. Obviously, acitretin is the more effective therapeutic agent compared to isotretinoin.
  • Immunomodulating therapeutics: For immunomodulators such as dapsone, cyclosporine A, methotrexate, colchicine or corticosteroids, there are insufficient clinical data available (Schneider-Burrus S et al. 2018).
  • Other: Continue consistent daily local disinfection. Laser epilation of the affected areas is recommended, if necessary complete excision of nodular inflammation; if possible primary closure; alternatively secondary healing of the defect.
  • Comedones: If comedones are detected, consistent removal by means of punch biopsies.

Advanced clinical pictures:

  • Drug therapy: Adalimumab (Humira®) is approved since 2015 and seems to be a promising option (Zouboulis CC et al 2019).
  • Surgical measures: In advanced disease, the only curative measure is the earliest possible surgical intervention with generous en-bloc resection of the affected areas. Even larger defect areas remain open postoperatively and can be secondarily granulated and epithelised under careful wound monitoring. If defect coverage is necessary, free grafts should be weighed against swivel valve plastic surgery. Here too, systemic treatment with retinoids can be performed preoperatively, 3-4 months before the planned procedure. Postoperatively, this treatment should be continued for several months.

General measures:

  • Smokers should be strictly forbidden to smoke.
  • If present, treatment of anemia.
  • Avoid wearing tight clothing (e.g. jeans).

Progression/forecast
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Without therapy, often decades of disease careers.

Note(s)
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The entity of the clinical picture is controversial. Relationships to perifolliculitis capitis abscedens et suffodiens, acne conglobata and hidradenitis suppurativa are discussed (see also clinical classification and therapy). The term acne inversa is partly used synonymously with acne triad, acne tetrade and hidradenitis suppurativa.

Literature
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  1. Küster W et al (1991) Acne inversa. dermatologist 42: 2-8
  2. Lentner A et al (1992) Clinical appearance and therapy of Pyodermia fistulans sinifica (Acne inversa). Z Hautkr 67: 988-992
  3. Stein A et al (2003) Acne inversa. dermatologist 54: 173-185
  4. Wienert V et al (2002) Acne inversa (stage 2). dermatologist 53: 18-21

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020