Acne inversa (Hidradenitis suppurativa, recurrent abcesses of the sweat glands, fistulating pyoderma)
For decades, we have dealt with this disease at the University Hospital Hamburg-Eppendorf and distilled the follwing therapeutic strategies:
Acne inversa (synonyms are: Hidradenitis suppurativa, recurrent abcesses of the sweat glands, fistulating pyoderma) is a chronic disease that typically affects the axilla, the groin, the crease of the butt and the area underneath the breasts.
- Thie disease is more common in smokers. A clinicall study, we performed, demonstrated that 100% of the affected individuals were heavy smokers. Thus we demand teh following procedure:
- Strict prohibition of smoking, to stop the progress of the diesease.
- Recommendation: Reduction of excess weight (weight loss), to prevent friction of skin folds.
- Prescription of the drug DADPS (diaminodiphenylsulfone). With this medication, healing of the inflammed lesions can be induced. However, the improvement only lasts as long as the drug is taken. Negative side-effects that are to be expected with this drug, are: methemoblobinaemia, i.e. the ability of the red blood cells to transport oxygen, is reduced. In general, this bears no hazard, however, in heavy smokers, the carbon monoxyde of the leads to similar effects, thus smoking has to be stopped also for this reason.
- Therapy with DADPS is carried out for 6 months. Typically, the inflamed lesions heal and potential residues may be surgically removed at this point, if necessary. As DADPS does not eliminate the propensity to develop this disease, removal of remaining nodules is indicated to prevent recurrences.
- The operation is typically performed under local, tumescent, anesthesia, in extensive disease, genearal anesthesia is required.
- During the operation, the affected areas with fistulas and nodules are excised, and the operation field is closed at the same session, if possible. In extensive disease, skin transplantation or secondary wound healing (healing from the sides) might be required for the defect to heal.
- In summary, one may conclude:
- The cause of the disease is still unknown.
- Smoking plays a key role, so strict cessation of smoking is mandatory!
- For best long-term results, first drug therapy should be carried out to reduce disease activity, followed by an operation to completely remove affected lesions.
If the patients adhere to these procedures, excellent treatment results can be expected.
