Also called as Hidradenitis Suppurativa, Acne Inversa is a chronic inflammatory skin disease that is characterized by the appearance of pus filled blackheads, pustules, nodules, reddish bumps and abscesses. The condition is extremely rare in individuals but is severe enough to cause distressing physical and psychological problems.
At times, severe cases of acne inversa can cause pus leakage from the pustules, blackheads and nodules and can possibly even cause permanent scars, blemishes and skin degradation. The condition can also remain without abating for months on end, causing severe physical and emotional stress for the individual.
Common Misconceptions about Acne Inversa
Many individuals believe that acne inversa is related to acne in some way (the name usually creates the confusion). However, acne inversa has nothing to do with acne. While acne is a disorder related to the skin, acne inversa is a chronic disease that is related to a specific type of sweat gland in the body (called the apocrine gland). And even though the symptoms of acne and acne inversa may look similar at first, the advanced symptoms of acne inversa would differ considerably than those of traditional forms of acne.
It has also been noted that acne inversa does not occur due to factors like poor hygiene (dirty, unkempt skin) or a unhealthy lifestyle (unhealthy food choices and habits), factors that largely contribute to traditional acne in individuals.
Causes for Acne Inversa
Acne Inversa is said to be caused by overactive apocrine sweat glands in the body. In certain cases, these glands would secrete excess sebum or fluids which would trap the oils, dead skin cells, bacteria and other impurities beneath the hair follicles and pores in the skin.
The blockage would cause small blackheads and abscesses to erupt on the skin surface. As the blockage increases in size, the trapped impurities start pushing into nearby tissues. This would eventually lead to the formation of skin lesions and lumps filled with pus. Extremely hard and painful to the touch, these lesions can easily reach the size of a golf ball and would drain at regular intervals (not a pretty sight at all).
Risk Factors of Acne Inversa in Individuals
Although there is no particular reason for an individual to contract acne inversa, studies have revealed that certain risk factors make the skin more vulnerable to chronic infections and diseases, including acne inversa.
Accordingly, some of the more common risk factors that could contribute to acne inversa in individuals include hormonal surges, genetic traits (handed down via the family tree), obesity, excessive body heat, humidity, stress and smoking etc.
Symptoms of Acne Inversa in Individuals
Acne Inversa is more prone to occur in areas of the body where the skin frequently rubs together. The condition is also prevalent in the areas which house plenty of sweat and oil glands. Accordingly, areas like the armpits, groin, thighs and the anal region are more vulnerable to the condition.
The symptoms of acne inversa usually start with a small bump or abscess that quickly transforms into small black spots and blackheads which appear all over the affected area. This is usually accompanied by other symptoms like a severe itching or burning sensation that spreads over the area. Some individuals experience excessive sweating in the area as well.
With time, the blackheads would transform into deep (and extremely painful), pus filled boils, lumps and sores which enlarge and break, causing the pus to ooze out and spread the infection. Leaking sores and lumps are also general symptoms of severe cases of acne inversa.
The symptoms of acne inversa usually last for many months (even for years on end in some cases). In several cases, the leaking pustules would lead to the developments of tunnels under the skin surface, leading to skin degeneration. Ruptured skin lesions could also cause open wounds and scars that would remain on the skin until treated separately.
Complications arising from Acne Inversa
Acne Inversa can cause a series of health related issues and complications in individuals. These include reduced mobility in the affected area, development of fistulas or tunnels (abnormal connections between epithelial organs and blood vessels that otherwise do not connect with each other), anemia, development of malignant tumors in and around the affected area, chronic lymphedema and mental instability etc.
Treatment of Acne Inversa
The treatment of Acne Inversa would largely depend on the extent of infection and the severity of the condition. Acne Inversa is usually divided into three stages of development, with the treatment being different for each stage.
Stage 1 Treatment
Mild cases of acne inversa can be treated using general health care measures like proper cleansing and good hygiene. Washing the affected area with an antibacterial soap can help reduce the inflammation and curb the infection that causes acne inversa.
Applying a warm compress over the affected area would also help clear out clogged pores, thereby making it easier to flush out the sebum, oil, dead skin cells, bacteria and other impurities that cause the infection.
Stage 2 Treatment
A comparatively severe case of acne inversa can be treated using prescribed oral and topical antibiotics. These would work actively against the infections causing the condition and prevent future recurrences. However, these antibiotics would need to be used for years on end (even peramently) to get relief from acne inversa and prevent future occurrences.
Oral retinoids, trimethoprim sulfamethaxazole, tetracycline, Non-steroidal anti-inflammatory drugs (NSAIDs ) and certain birth control pills are usually prescribed to treat mild-severe cases of acne inversa in individuals. These drugs can prevent the blockage of hair follicles and pores, thereby preventing the infection from spreading into the skin.
Some topical antibiotics that are generally prescribed for acne inversa include clindamycin and corticosteroids etc. Application of topical corticosteroids (creams or ointments that contain ingredients like benzoyl peroxide and salicylic acid) on the pustules and boils can bring down the swelling and pain caused by the infection to a great extent.
In certain rare cases, steroidal injections would be administered to the pustules and boils to reduce inflammation and drainage. These would also need to be given over a period of time until the pustules and boils disappear; after which the individual is switched to antibiotics to prevent further outbreaks.
Stage 3 Treatment
Extremely severe cases of acne inversa would need to be treated by surgical means or radiation therapy.
In the case of radiation therapy, concentrated destructive lasers are aimed at the blocked hair follicles. This procedure would destroy the hair follicles completely but would cause permanent scarring in the process.
In the case of a surgery to treat acne inversa, a doctor would start by making an incision into the lump/boil and draining the pus collected inside it. He/she would then proceed to surgically remove the lesion along with all the fistules underneath it. This would be followed by the complete removal of the infected skin (usually from other parts of the body where the infection has spread as well). The wound (or wounds) is then closed using skin grafts taken from healthy, unaffected areas of the body.
Though the final procedure would be the only way to get rid of acne inversa once and for all, it could cause visible scars on the skin. An individual would also need to opt for multiple skin grafting sessions to close these scars. The recovery period is lengthy and extremely painful as well.