Hidradenitis suppurativa (acne inversa) is a clinical form of acne in which acne is accompanied by a secondary inflammatory process in the apocrine sweat glands with the appearance and opening of subcutaneous infiltrates in the armpits, in the navel and perineum, around the nipples. The disease proceeds chronically with frequent relapses. Adequate antibiotic therapy, including systemic oral administration of antibiotics and their external use, plays a leading role in the treatment of hidradenitis suppurativa.
Inversion acne occurs only after puberty, since it is at this age that the apocrine glands begin to function. Initially, inflammation occurs in the hair follicles and this process is no different from the mechanism of occurrence of vulgar acne. After an increase in inflammatory infiltrate and rupture of the hair follicle wall, secondary infection of the apocrine sweat glands occurs. Often inversion acne appears on the background of a severe form of acne. Their development is promoted by obesity, itching or constant friction of clothing in the places of localization of apocrine glands.
The disease is manifested by the formation of multiple infiltrates under the skin in the armpit, perineum, near the navel or around the nipples of the mammary glands. They look like small bumps on the skin, when felt, painful seals are revealed. After some increase in size and maturation, the infiltrates are opened. Purulent or purulent-bloody discharge comes out of them on the surface of the skin. Then healing occurs with the formation of a retracted scar at the site of infiltration. Scarring of some hidradenitis suppurativa, as a rule, is accompanied by the appearance of new ones and the expansion of the skin lesion area.
Hidradenitis suppurativa is characterized by a constantly recurring chronic course and can be considered one of the varieties of chronic pyoderma.
Therapy of hidradenitis suppurativa is a rather long process, sometimes taking several months. The basis of treatment is antibiotic therapy. Ointments with antibiotics are applied locally twice a day: tetracycline, erythromycin, lincomycin, lotion with clindamycin. In parallel, therapy is carried out aimed at preventing blockage of hair follicles and improving the oxygen supply of tissues. So an effective treatment scheme for hidradenitis suppurativa is a combination of erythromycin ointment and benzoyl peroxide.
Local treatment is combined with a course of oral antibiotics. For this purpose, doxycycline, sulfamethoxazole + trimethoprim, clindamycin, tetracycline, erythromycin, etc. can be used. For a more accurate selection of the antibiotic, the seeded acne is seeded and the sensitivity of the sown microflora to antibiotics is determined. Synthetic retinoids are also used in the treatment of hidradenitis suppurativa, and in women — hormonal therapy: ethinyl estradiol, ciproterone, etc. In the acute inflammatory period, mechanical and thermal methods of treatment are contraindicated: peeling, massage, hot baths, etc.
Important in the treatment and prevention of subsequent recurrences of hidradenitis suppurativa is not only personal hygiene, but also proper skin care. The selection of cleansing gels, cosmetics and preventive creams for maintenance therapy should be carried out in conjunction with the attending dermatologist or dermatocosmetologist.