Acne inversa: influence of associated factors in the extent of the disease and the result of surgery

Abstract

Acne inversa is a chronic inflammatory disease with fistulas and abscesses of unknown etiology. A number of trigger factors have been identified, but their influence on pathogenesis and severity of the disease is controversial. In a retrospective study we analyzed 84 patients with AI who underwent 113 surgical procedures. Well-known external and internal trigger factors as well as the surgical procedure and its outcome together with parameters of quality of life and patient satisfaction were assessed. The median severity of disease (Sartorius score) was 43.4 without any gender differences. The amount of smokers was extraordinarily high with 93%, but there was no correlation between smoking and disease severity. Obesity (77% in all patients), the age of primary manifestation of AI, family history of AI, atypical locations, and history of severe acne were significantly associated with the Sartorius score and therefore with AI severity. Except for age of primary manifestation and history of severe acne, the mentioned factors were independent predictors for disease severity in multivariate analysis. The postsurgical recurrence rate was 12.4% and significantly higher in heavy smokers. However, there was no relation between recurrence rate and wound closure. The evaluation of patients' self- assessment on life quality showed a postsurgical improvement of 70%. The wide surgical excision of all lesions followed by spontaneous healing or split-skin grafting leads to a reasonable recurrence rate and improves the affected patients' quality of life for a prolonged period of time.