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Acne inversa
A blocked hair follicle, not a question of hygiene — and treated early it leaves the scars behind.
Also known as: hidradenitis suppurativa · acne inversa · chronic abscesses in skin folds (armpit, groin)
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Hidradenitis suppurativa is a chronic inflammation of the skin in the folds: armpits, groin, buttocks, under the breast. It usually starts after puberty with deep, painful lumps that come and go. Later abscesses can form from them, tracts under the skin that discharge fluid, and scars that pull the skin together. One point belongs at the start, because it is so often misunderstood: it does not come from poor hygiene and is not catching. The starting point is a blocked hair follicle that bursts and inflames its surroundings — despite the name, sweat glands are not the cause. Exactly this misunderstanding is why many people feel ashamed and wait years on average before showing it to anyone. That is the real tragedy, because treated early the scarring can largely be prevented, and there are effective treatments today, up to antibodies. Smoking and excess weight clearly worsen the course, and repeated lancing alone does not solve the problem — the tracts remain and fill again.
An abscess sometimes has to be relieved, but lancing again and again does not change the course. What works are treatments that damp down the inflammation itself — and, with established tracts, a targeted procedure.
Washing more often and more harshly improves nothing and irritates the skin further. Knowing this makes people show it sooner — and that is the biggest gain of time here.
Smoking is linked with more severe courses, and stopping noticeably improves the skin for many. It is the step with the greatest effect one holds oneself.
Loose, breathable clothing, no seams over the affected areas, no wet shaving but trimming instead. Small changes that make flares less frequent.
Waist size, blood pressure, sugar and blood fats belong here. Working on them gains something for the skin and for the heart at the same time.
The second name, acne inversa, misleads. The treatment follows different roads, and what helps against acne on the face often does not work here.
These lumps hurt a great deal and limit sitting, walking and sleeping. Pain treatment belongs explicitly to it — and so does the emotional weight of the illness.
About one in a hundred people is affected, women more often, usually starting between twenty and thirty. From the first signs to the right diagnosis, seven to ten years pass on average — it is long taken for a recurring abscess. Smoking and excess weight worsen the course measurably. An antibody against TNF works in about half; it is judged after twelve to sixteen weeks. Scarred tracts do not recede.
Antibiotics are given here not for an infection but for their anti-inflammatory effect — clindamycin locally, doxycycline over twelve weeks. An antibody against TNF works in about half, judged at twelve to sixteen weeks. What no treatment does: make scarred tracts recede — they stay and need a procedure. Lancing alone relieves briefly and almost always returns; the tracts must be removed with it.
Armpits, groin, buttocks, under the breast and between the thighs — where skin rubs on skin. A lump in changing places speaks more for something else.
Twice or more within half a year in the same place: this repetition is what separates the illness from a single boil.
If fluid keeps coming from an opening, a tract lies underneath. It no longer closes by itself, and simply lancing it is not enough — there are targeted procedures for that.
Two black dots lying side by side in scarred skin are a very specific sign. Anyone who knows them often recognises the illness at first glance.
Tight clothing, heat and friction worsen the flares, and in many women they come regularly before the period. This pattern helps in arranging everyday life.
Shows how strong the inflammation currently is and helps in judging a flare. The diagnosis is made by eye, not by the value.
Like the CRP a measure of the inflammatory load over a longer period. In severe courses it stays raised.
This illness often goes with a disturbed sugar metabolism. Finding that is worthwhile quite apart from the skin — and often improves it too.
With long, extensive inflammation an anaemia develops that makes one tired. The value is falsely high in that case — so the transferrin saturation belongs alongside.
The illness begins after puberty and in many women swings with the cycle — both point to the influence of male hormones on the hair follicle. Several hormonal treatments rest on that.
A reduced action of insulin is often present and at the same time strengthens the androgens. That is why sugar metabolism and skin are treated together here.
Many women describe flares regularly before the bleeding. Holding this pattern in a calendar is real information for the choice of treatment.
Some benefit from less sugar/dairy — individual.
Studied at 90 mg zinc gluconate a day over 3–4 months; small studies found fewer flares. At this dose and duration copper uptake is disturbed — that belongs considered.
Stopping smoking and losing weight are the two factors with the strongest influence on the course. For dairy and yeast there are reports but no controlled studies.