When Alison wrote me and suggested I do a Malady of the Month on Acne Inversa I thought, hmmmm, I'll take a look but, really, how bad can acne be? The answer turned out to be: Quite Horrible Indeed! Now, even an old Comtesse such as myself has the occasional outbreak of acne, but Acne Inversa (which is also known as Hidradenitis Suppurativa) is something that not even Proactiv Solution can help!

Acne Inversa, as the name implies, is essentially acne that grows internally instead of externally. eMedicine aptly describes it as "an annoying chronic condition characterized by swollen, painful, inflamed lesions in the axillae, groin, and other parts of the body that contain apocrine glands." The apocrine glands are the sweat glands that reside in hair-covered parts of the body, mainly the armpits and genital areas. They are responsible for producing that particular brand of smelly sweat of which we are all quite familiar. With Acne Inversa the glands become blocked and all of that perspiration and accompanying bacteria gets forced into the surrounding tissues rather than being released as sweat. Naturally, this leads to some very nasty infections and inflammations.

Acne Inversa is quite painful (as you might expect), but is not a life-threatening condition. However, the disfiguration that it causes can be emotionally devastating to the individuals afflicted, especially regarding sexual relationships. Luckily, the disease is relatively rare, afflicting only about 1% of the population, with a larger number of females afflicated than males.

There is no cure for acne inversa, but there are a number of treatments that can reduce the inflammation and minimize future outbreaks, such as antiobiotics, oral retinoid medications, anti-inflammatory drugs, and corticosteroids. Severe outbreaks may require surgical intervention, including incision and drainage of the lesions, cutting away the skin and flesh that cover any tunnels or tracts, or surgical removal of the skin (followed by skin grafts). Youch!

Removal of a bandage over an incised lesion - note the skin sticking to the bandage. Ouch!!!	Sometimes the lesions are stuffed with a thin bandage called a "wick" that captures the draining puss. Here, the wick is being removed from the lesion. OUCH!!!!

Acne Inversa: a most unpleasant affliction!