Acne Inversa — Chronic, relapsing inflammatory skin disease involving the pilosebaceous unit
Epidemiology
- Prevalence: ~1–4%
- Onset: post-puberty, usually 20–40 years
- Female predominance (≈3:1)
- Strong association with:
- Smoking
- Obesity
- Positive family history in ~30–40%
Aetiology
- Follicular occlusion (primary event)
- Genetic predisposition (autosomal dominant in some families)
- Hormonal influences (androgens)
- Environmental factors (smoking, friction)
Pathophysiology
- Follicular hyperkeratosis → follicular occlusion
- Follicular rupture → release of keratin and bacteria
- Intense inflammatory response
- Abscess formation → sinus tracts and fibrosis
Clinical presentation
Primary Lesions
- Painful deep-seated nodules
- Abscesses
- Purulent discharge
- Double-ended comedones (pathognomonic)
Chronic Lesions
- Sinus tracts
- Hypertrophic or atrophic scars
- Fibrosis
Common Sites
- Axillae (most common)
- Groin
- Perineal and perianal regions
- Inframammary folds
- Buttocks
🧩 Severity Classification (Hurley Staging)
Stage | Description |
Stage I | Abscesses without sinus tracts or scarring |
Stage II | Recurrent abscesses with sinus tracts and scarring |
Stage III | Diffuse involvement with interconnected tracts |
Investigations
- Clinical diagnosis
- Recurrent lesions in typical locations
- Chronicity and scarring
- No specific laboratory test
Management
General Measures
- Weight reduction
- Smoking cessation
- Loose clothing
- Hygiene and antiseptic washes
Medical Therapy
Severity | Treatment |
Mild | Topical clindamycin 1% 2x/day for 12 weeks |
Moderate | Oral tetracyclines 500 mg 2x1 for 16 weeks |
Severe | Oral clindamycin 300 mg 2x1 + rifampicin 600 mg 2x1 for 10 weeks |
Refractory | Biologics (adalimumab) |
Hormonal | Antiandrogens in women |
Procedural & Surgical Treatment
- Intralesional corticosteroids
- Incision and drainage (acute abscess)
- Laser therapy (Nd:YAG)
- Wide surgical excision (definitive)
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