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How do I recognize acne inversa

Symptoms & course of acne inversa

In general, the symptoms of acne inversa (acne inversa) can appear anywhere on the body. The typical skin changes occur particularly often in areas with many hair roots or sweat glands, for example on the armpits and in the groin area. Also areas where skin rubs against each other, e.g. Symptoms, for example on the buttocks, on the inside of the thighs or under the breast in women, often show the symptoms.

Possible complaints with acne inversa

  • Painful, pea-sized lumps
  • Abscesses (encapsulated collection of pus in the tissue caused by inflammation)
  • Fistulas (inflamed tubular duct that may form from an abscess, for example)
  • Reddened areas of the skin
  • Scarring on the affected areas of the skin
  • Unpleasant odor development, which can result from the wetting of the skin changes

Acne inversa in pictures

Small lumps, here in the armpit, are typical symptoms of acne inversa.

The lumps in acne inversa can also occur in the groin area.

If the acne inversa has progressed, fistulas and scarring can occur. Seen here in the armpit.

Course of acne inversa

How the disease will develop over time varies widely and cannot be predicted. In many cases, however, the symptoms keep recurring and worsen over time. Early diagnosis is critical so that appropriate treatment can be started quickly. In this way, the progression of the disease and its consequences, for example scarring, can be counteracted. If you have symptoms that could be caused by acne inversa, contact a dermatologist who specializes in acne inversa directly.

Interview: abscesses in acne inversa

Abscesses are one of the particularly annoying and painful symptoms of acne inversa. Once healed, they often return. Why this is so and how abscesses can be treated, explains Dr. Sylke Schneider-Burrus, head of dermatosurgery and acne inversa focus at the Berlin Charité. She looks after many patients with chronic inflammatory skin diseases during the Acne Inversa consultation.

Dr. Sylke Schneider-Burrus: Abscesses are acute infections that develop within a few days and are very painful. They occur in all stages of acne inversa. However, they are often the first thing to happen when someone develops acne inversa. In the early stages, abscesses are often the first symptom that is noticed in the disease.

An abscess is a cavity filled with pus. There are bacteria and dead white blood cells in the pus. Abscesses sit in the deeper regions of the skin and in fat tissue. They are mainly noticeable through pain as well as overheating and reddening of the affected skin area.

Dr. Sylke Schneider-Burrus: A problem in patients with acne inversa is that the innate immunity - also known as innate immunity - of the skin is less pronounced than in healthy people. The factors that are responsible for the initial bacterial defense in the skin are present to a lesser extent. This makes bacterial infections faster. This leads to lumps that become inflamed and become abscesses. If fistulas have formed in the further course of the disease, bacteria can also settle there, multiply and form further abscesses. If Acne inversa has anatomical changes in the skin - such as scars or fistulas - there is an increased likelihood of recurring inflammation and abscesses in these areas.

Dr. Sylke Schneider-Burrus: Abscesses, even if they occur in areas typical of acne inversa, such as under the armpits, can also have other causes. An abscess can develop from an inflamed hair follicle even in an otherwise completely healthy person, for example after shaving. That alone is not acne inversa. In addition, there are more and more young people in particular who are carriers of a very contagious strain of Staphylococcuc aureus, a type of bacteria that can repeatedly cause abscesses. There are also a number of other conditions that can lead to abscesses. If acne inversa has not yet been diagnosed and abscesses occur, a careful investigation should therefore always be carried out to determine whether acne inversa or another cause is hidden behind the symptoms.

Dr. Sylke Schneider-Burrus: The most important thing is the opening of the abscess cavity. Usually this is done through an incision, that is, the abscess is opened with a scalpel. One then speaks of an abscess splitting. This will allow the pus to drain and the pain will subside immediately. In addition, the healing process can also be promoted by antibiotics. Alternatively there is the possibility with z. B. tar ointment to encourage an abscess to open on its own. The most important thing in any case is to bring about the opening of the abscess.

Then it is ensured that the abscess cavity does not close again immediately. Otherwise the abscess may fill up with pus again and will not heal. The opening in the abscess cavity can be kept open with a small drain (e.g. a rubber strap or a piece of gauze). Extensive removal or peeling of tissue is usually not necessary in the case of an abscess. At a later time - after the inflammation has subsided - the skin in the same area should be examined again to decide whether the remains of the abscess cavity should be removed with a small operation.

Dr. Sylke Schneider-Burrus: An abscess should always be opened by the doctor. He can accurately assess whether an abscess can be opened. This is the case when pus has already accumulated. In addition, the treatment at the doctor ensures that the surrounding tissue does not become inflamed further or that a rash, an infection caused by bacteria, forms. Even if an abscess has opened by itself, the responsible doctor should be consulted for further treatment.

Dr. Sylke Schneider-Burrus: Of course, it is important not to put additional pressure on the region of the abscess. But this is usually avoided anyway because of the pain. Painkillers can also be taken - in consultation with the attending physician. As the abscess heals, it is important to follow what the treating doctor has recommended - such as using disinfectant bandages or what to watch out for when showering.

Dr. Sylke Schneider-Burrus: Generally, there is no single behavior that can prevent abscesses from occurring. The consistent and effective treatment of acne inversa is important. When the disease is controlled, the risk of abscess formation is also lower. Smoking appears to encourage abscess formation. In addition, weight control should be aimed for in acne inversa. Obesity has a negative effect on the course of the disease and thus also on the formation of abscesses.

Acne inversa: severity

The symptoms of acne inversa can take different forms. The severity of the disease is an important criterion in choosing treatment. There are three different degrees of severity: easy, moderate and difficult. Doctors use so-called scores to determine the severity. A score is a point value that is awarded for certain characteristics or manifestations of a disease and enables their severity to be classified.

A new and precise score for Acne inversa that can be easily calculated is the so-called IHS4 *. He divides the disease according to the number and type of skin changes: 1 point is awarded for each lump, 2 points for each abscess and 4 points for each fistula. The sum of the points gives the value of the IHS4 and enables the severity to be determined:

  • A easy Acne inversa is included 1 to 3 points in front.
  • Moderate the disease is at 4 to 10 points.
  • Heavy is acne inversa at 11 or more points.

The IHS4 was developed by European experts in a comprehensive consensus process and has proven to be a reliable method for recording the severity of acne inversa. Another score is the Hurley classification, with which the disease is divided into stages I to III. However, it is only suitable to a limited extent for assessing the severity of the disease in connection with the therapy.

*I.nternational Hidradenitis S.uppurativa S.everity S.core S.ystem = international points system for the severity of acne inversa

Comorbidities in acne inversa

Acne inversa (acne inversa) shows up primarily on the skin, but there may be other ailments related to the disease. They are called comorbidities. If you have been diagnosed with acne inversa and you have the impression that you have symptoms of one of the mentioned concomitant diseases, talk to your dermatologist about it. He can initiate treatment or refer you to another specialist.

The following diseases are among the comorbidities of acne inversa:

Spondyloarthropathy (SpA) is an inflammatory disease of the spine. It usually shows up as back pain that occurs gradually and gets better with movement.

Crohn's disease is a chronic inflammatory bowel disease that is characterized by inflammation in the digestive tract. Abdominal pain and diarrhea are typical symptoms of Crohn's disease.

Signs of depression can include: B. a persistent, depressed, depressed mood, listlessness, loss of interest and hopelessness.

Common symptoms of severe acne (acne vulgaris) include deep, tight lumps and sores that can be very painful. The symptoms of severe common acne and acne inversa can be similar, so they can be mixed up. However, they are different diseases that are also treated differently.

The metabolic syndrome is a combination of different metabolic disorders. It includes obesity, high blood pressure, changes in blood lipid levels and a disorder of the sugar metabolism.

The risk of a certain type of skin cancer, squamous cell carcinoma, is increased after long-term inflammation, especially in the genital area and around the anus. Regular preventive examinations are therefore particularly useful if acne inversa has been around for a long time.

Polycystic Ovary Syndrome is a hormonal disorder in women in which there is an increased production of male hormones. Menstrual cycle disorders, obesity and reduced fertility can be among the consequences.

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  • Recognize, prevent and treat comorbidities

Diagnosis of acne inversa

Early diagnosis of acne inversa (acne inversa) is important. This is the only way to start the right treatment quickly and to control the disease in the best possible way. However, recognizing acne inversa is often a challenge. In many cases, it is particularly difficult to distinguish it from symptoms of other diseases. At first, acne inversa can be similar to severe common acne or an inflammation of the outer part of the hair follicle (folliculitis).

There is no single examination with which the dermatologist can clearly determine acne inversa. He receives the most important information about the disease from the physical examination and a detailed discussion with the patient.

Physical examination and discussion with the doctor

During the conversation, the dermatologist asks about the medical history (anamnesis). In this way, he can find out when the symptoms started, whether they were recurring and whether there are other family members with acne inversa. During the physical examination, the doctor can assess whether characteristic changes have formed on the skin in typical areas of the body.

Laboratory values ​​and other procedures

There are some blood tests that can give you a clue as to whether there is inflammation in the body. One of them is C-reactive protein (CRP). This protein is found in the blood. If there is inflammation in the body, its concentration increases. The erythrocyte sedimentation rate (ESR) is also an indicator of inflammation in the body. After a while, the red blood cells settle in a tube with a blood sample. The speed at which this happens is called the ESR. Inflammation can accelerate the ESR and thus increase this value. Acne inversa cannot be determined with certainty, but the values ​​can provide an indication of the disease.

The examination of a smear in the laboratory can also provide information about whether there is an infection and, if applicable, also which pathogen is causing the problem. An ultrasound examination (sonography) or magnetic resonance imaging (MRI) can be used to determine how far abscesses or fistulas have expanded.