“Hidradenitis suppurativa” is acne inversa! An appeal to (finally) abandon a misnomer

Abstract

The term "hidradenitis suppurativa" is firmly entrenched in the dermatological literature although it refers to a false pathogenetic concept. The term was historically coined based merely on the characteristic distribution of the apocrine glands and the anatomical coincidence with the disease process. At center stage is not a suppurative inflammation of the apocrine sweat glands but an occlusion of the hair follicles, comparable to acne vulgaris. Reviewing the literature on this subject, we were astonished to find that even articles that concluded that the entity represents a form of follicular occlusion still referred to it as hidradenitis suppurativa. The disorder shares histopathological and clinical aspects with acne vulgaris modified under the special circumstances of anatomical regions rich in apocrine glands. It is acne inversa because, in contrast to acne vulgaris, the disease involves intertriginous localizations and not the regions classically affected by acne. We suggest that the term "hidradenitis suppurativa" for this disease should (finally) be abandoned in favour of "acne inversa".

Microbial Profile and Antimicrobial Susceptibility of Bacteria Found in Inflammatory Hidradenitis Suppurativa Lesions

“…However, other studies found even higher rates of negative cultures [18,31]. In HS, fistulas may contain solely granulomatous inflammatory infiltrates with predominantly histiocytes and multinucleated giant cells, without significant bacterial growth [32,33]. Besides, due to the used culture conditions, distinct bacterial species may not grow.…”

Operative Therapie der Acne inversa

“…Erst mals be schrieb Vel peau im Jahr 1839 das Krank heits bild mit ent zünd li chen, ober fläch lich ab sze die ren den Ver än de rungen im Be reich der Axil len, der Brust und der Pe ria nal re gi on [24]. Auf grund der Schweiß drü sen ver tei lung und der ana tomi schen Nähe des Ent zün dungs pro zes ses zu die sen präg te zwi schen 1854 und 1865 der fran zö si sche Chi rurg Ver neuil den Begriff "hi dro sa dé ni te phleg mo neu se" [24].…”

“…Auf grund der Schweiß drü sen ver tei lung und der ana tomi schen Nähe des Ent zün dungs pro zes ses zu die sen präg te zwi schen 1854 und 1865 der fran zö si sche Chi rurg Ver neuil den Begriff "hi dro sa dé ni te phleg mo neu se" [24]. Nach dem Shel ley und Cahn 1955 in ei nem ok klu si ven Mo dell di la tier te, ent zün de te apo kri ne Drü sen gän ge nach wei sen konnten, pos tu lier ten sie, dass die "Hi dra de nitis sup pu ra ti va" eine bak te ri el le In fek ti on ver schlos se ner apo kri ner Drü sen sei [25].…”

Absence of Efficacy of Oral Isotretinoin in Hidradenitis Suppurativa: A Retrospective Study Based on Patients’ Outcome Assessment

“…Despite its historical name referring to sweat glands, it is a disease of the follicular apparatus, particularly of the areas where apocrine glands are present. Therefore, some authors called it acne inversa [1]. In analogy to acne, isotretinoin has been considered in the treatment of HS and has frequently been used in this context.…”