Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment

Abstract

Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring.

Hidradenitis suppurativa

“…Hurley's stages (Table 3) Revuz documented 68.2% of patients in Hurley's stage I, 27.6% in Hurley's stage II, and 3.9% in Hurley's stage III [9]. From a practical point of view, a patient with Hurley's Stage III really has all three stages and may present with burned-out Stage III but active Stage I or II lesions.…”

“…Some patients with HS/AI treated with TNFa for 1 year achieved average recurrencefree intervals of 9.5 months for etanercept and 21.5 months for adalimumab [27]. Infliximab reduces pain intensity and disease severity and improves the quality of life.…”

“…The immune response, whether contributing to the etiology or reacting to subcutaneous material, is modified by immunosuppressants. They control but rarely clear the disorder [27,36]; therefore, they are best considered adjuncts to dietary and metabolic management, other medications, and surgery.…”

“…Medical treatments include antibiotics, hormonal management, and immunosuppressives (e.g., corticosteroids, cyclosporine, tumor necrosis factor alpha (TNFa) and interleukin (IL) inhibitors) [27]. Acitretin [28] and even isotretinoin in low dose are worth considering in early cases as gentle concurrent prophylactic therapy.…”

Pyoderma gangrenosum—a systemic disease?

“…8,9 Acne can be associated with PG, sometimes in rare syndromes like PAPA (pyogenic arthritis, PG, and acne) or PAPASH (pyogenic arthritis, PG, acne, and hidradenitis suppurativa / inverse acne). 10 The association of PG with internal disorders has an impact on the choice of treatment. 2,7 Morbidity and mortality of patients with PG depends on both, PG and associated disease.…”