Hidradenitis suppurativa/acne inversa – diagnostika a léčba

Dermatol. praxi. 2019;13(4):168-173

Hidradenitis suppurativa/acne inversa – diagnosis and management

MUDr. Eliška Langerová: I. DVK FN u sv. Anny v Brně a LF MU Brno

Hidradenitis suppurativa or acne inversa is a chronic, inflammatory, reccurent, debilitating skin disease that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillaries, inguinal and anogenital regions (Dessau definiton, 1st International Conference on Hidradenitis suppurativa, March 30-April1, 2006, Dessau, Germany). Hidradenitis suppurativa is very serious illness with certain complications and comorbidities and refractory results for the patients, but unfortunatelly it is still either lately or misdiagnosed. Prevalence is 1% of population. It starts after puberty and the incidence declines after fifth decade. Women are more prone to hidradenitis suppurativa. Primary patological proces is localised to the terminal hair follicle with ongoing apocrine gland involvement. Clinically we see comedones, painfull deep-seated inflamed nodules, abscesses, draining sinuses, scarring, secondary lymphedema. Hurley scale devides the patients into three stages according to the clinical picture. Other dynamic scaling systems are used. In 2015 were printed European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa, followed by therapeutical algorithm, which devides therapeutical options into three lines: 1st line (topical clindamycin 1%; systemic anibiotics: tetracyclin - doxycyclin, clindamycin + rifampicin; adalimumab), 2nd line (infliximab, acitretin/etretinate, zinc gluconate, resorcinol, intralesional glucocorticoids) and 3rd line (colchicine, botulinum toxinum, isotretinoin, dapson, cyclosporin, hormonal therapy – antiandrogens). Adjuvant therapy and surgery is necessary. Multidisciplinary attititude is important for the therapeutical outcome.