Acne Inversa and Diabetes

Diabetes has been clearly associated with hidradenitis suppurativa (HS) in the last years. HS is a chronic inflammatory skin disease that has a significant impact on patients’ quality of life. It is characterized by recurrent painful nodules, abscesses and draining tunnels in predominantly intertriginous areas. The average prevalence of HS ranges from 0.4% to 1%, with familial and sporadic forms of the disease. HS is mostly diagnosed by clinical observation and history. An emerging tool for the assessment of deep-seated lesions is ultrasound imaging. Severity grading is still enormously based on the Hurley staging system, whereas a new validated, dynamic classification, severity grading and outcome measure, the International Hidradenitis Suppurativa Severity Score System (IHS4), has been developed. Chronic symptoms or consequences of uncontrolled disease include pain, drainage, pruritus, odour, low self-esteem, sleep and sexual dysfunction, and poor mental health. The pathogenesis of HS is thought to involve follicular dyskeratosis, hyperkeratosis and dilatation, follicular rupture and chronic inflammation with architectural tissue changes. Apart from diabetes, HS is in general associated with metabolic syndrome and other cardiovascular risk factors, polycystic ovary syndrome and depression. It has also been mainly associated with other immune-mediated diseases, such as inflammatory bowel disease and spondyloarthropathy. HS has a profound negative impact on patients’ quality of life and is an under-diagnosed and under-treated disease. A multidisciplinary management approach may be required to ensure the best outcomes, given the associated comorbid disordersComorbid disorders. Few isolated lesions (mild disease according to IHS4) might be treated by topically applied preparations, and locally limited lesions (moderate disease) can be treated by conventional surgery or laser, whereas widespread lesions (severe disease) may be better treated with systemic therapy alone or in combination with radical surgery, if scarring is prominent. Systemic therapy may include antibiotics (clindamycin and rifampicin, tetracyclines), acitretin and biologic agents (adalimumab, secukinumab – registered biologics – but also infliximab, bimekizumab, anakinra (off label)). Adjuvant measures such as pain management, treatment of superinfections, weight loss and tobacco cessation must be taken into account.