Acne inversa

Acne inversa is a chronic inflammatory skin disease featuring cutaneous and subcutaneous nodular inflammation, fistula formation and discharge of foul-smelling secretions. The disease can lead to functional impairment and psychological problems. There is inflammation of the terminal hair follicles in intertriginous regions, especially perianal, axillary and inguinal areas. Less often there is submammary, periumbilical, retroauricular or nuchal involvement. Without treatment the disease is chronic and progressive. The causes of acne inversa are multifactorial and pathogenesis is still not well understood. Besides a positive family history, obesity and cigarette smoking are trigger factors. Early diagnosis and therapy of acne inversa saves the patient years of suffering. The most effective treatment is undoubtedly the radical wide excision of the affected areas. Local measures such as radiotherapy, photodynamic therapy and cryotherapy have provided little benefit; the same is true for systemic antibiotic treatment or hormonal therapy with anti-androgens. TNF-alpha antagonists seem to have a promising influence on the disease. Further studies investigating the effect of these substances on acne inversa are warranted.