Current treatment options for acne inversa

Acne inversa je kronična recidivirajuća upalna bolest kože koja se najčešće javlja u predjelu pazuha, prepona i anogenitalne regije. S obzirom na bol, neugodan miris, gnojenje i estetske nedostatke zahvaćenih područja kože, ova bolest uvelike utječe na kvalitetu života bolesnika. Acne inversa se najčešće javlja nakon puberteta, s vrhuncem obolijevanja u ranim dvadesetim godinama. Procjenjuje se da se bolest javlja tri puta češće u žena nego u muškaraca. Etiopatogeneza acne inversa je po svemu sudeći multifaktorijalna. Primarnim događajem se smatra okluzija terminalnog dlačnog folikula, koja je uzrokovana hiperkeratozom i hiperplazijom folikularnog epitela. Okluzija rezultira akumulacijom staničnog debrisa, formiranjem cisti i puknućem dlačnog folikula. U početnom stadiju acne inversa je karakterizirana pojavom nježnih subkutanih čvorića koji nalikuju na furunkul. S vremenom, čvorići se povećavaju i šire te često rupturiraju pa nastaju duboki i bolni apscesi. Liječenje acne inversa možemo podijeliti na nekirurško (medikamentozno), kirurško i lasersko liječenje te njihovu kombinaciju. Oblik terapije ovisi o težini bolesti odnosno stupnju zahvaćenosti kože. Antibiotici su osnovno uporište u liječenju ove bolesti. Kirurško liječenje je jedina metoda kojom se postižu više stope remisije ili izlječenje acne inversa. Svaki bolesnik zahtijeva jedinstven pristup ovisno o stupnju njegove bolesti i toleranciji rizika.Acne inversa is a chronic, recurrent and inflammatory skin disease that usually occurs on the skin of the axilla, groin, and anogenital regions. Due to pain, odor, pus and aesthetic deficiencies of the affected areas, disease greatly affects the patients' quality of life. Acne inversa usually appears after puberty. Disease occurs more often in women than in men. Ethiopathogenesis of acne inversa is multifactorial. The primary event seems to be occlusion of the terminal hair follicle, which is caused by hyperkeratosis and hyperplasia of follicular epithelium. However, the result of occlusion is accumulation of cellular debris, forming cysts and rupture of hair follicle. In the initial stage, acne inversa is characterized by the appearance of soft subcutaneous nodules that resemble furuncule. Over time, the nodules progressively increase and spread, they rupture and finally form deep painful abscesses. The rupture often leads to drainage of purulent content odor. Treatment of acne inversa can be divided into non-surgical, surgical and laser treatment, and combination of aforementioned methods. The form of treatment depends on the type and degree of involvement of the skin. Mainstay treatment for acne inversa are antibiotics. Surgery is the only therapeutic option that leads to higher rates of complete repression of acne inversa. However, every patient is different and requires the unique approach based on the stage of his disease and the tolerance of the risk