Verneuil’s disease is more commonly called Hidradenitis Suppurativa and is also called acne inversa. It is a chronic disease of the hair follicles that leads to the formation of nodules, abscesses and scars. It affects 0.05 to 4.10% of the population and occurs mainly in young African-American or mixed-race women.
Verneuil’s disease manifests mainly in the intertriginous areas, the armpit being the most frequent site. It can also manifest itself in areas of frequent skin compression and friction. Although the presentation may vary, most patients have similar clinical features.
- Appears after puberty as solitary, painful, itchy nodules that are often mistaken for a boil. Some may experience localized pain and itching as well as fatigue before the nodule appears.
- Recurrence of nodules.
- Disease progression to expanding abscesses forming sinus ducts.
- Drainage of the sinus ducts in the form of open multiheaded comedones with discharge and odor.
- Destruction of sebaceous glands and hair.
- Scars of varying severity. The formation of thick fibrotic bands (fibrosis) of scar tissue can restrict mobility and cause obstruction of the lymphatic system.
Verneuil’s disease can have a significant impact on quality of life and can lead to depression and impairment of a person’s social life and career. The risk of substance abuse and suicide increases significantly in people with Verneuil’s disease.
What are the causes of Verneuil’s disease?
The development of Verneuil’s disease highlights a dysfunction of the immune system causing hyperkeratosis, then rupture of the hair follicle and inflammation of the apocrine gland.
The risk factors are:
- A genetic predisposition: 30 to 40% of patients have at least one affected family member.
- Obesity.
- History of smoking.
- Unique skin flora.
- Earlier onset associated with more extensive disease.
The presence of Verneuil’s disease is associated with an increased incidence of comorbidities such as severe acne vulgaris, psoriasis, diabetes, hyperlipidemia, myocardial infarction and inflammatory bowel disease (including inflammatory bowel disease). of Crohn’s).
How is Verneuil’s disease treated?
Early treatment of Verneuil’s disease is recommended to stop progression and prevent complications by treating existing lesions and reducing the formation of new lesions. Treatment can also minimize the risk of the associated psychological burden and is determined by the severity of the disease.
Management of Verneuil’s disease may include:
- A skin care plan to reduce potential triggers.
- Wound care education.
- Pain control in the form of topical lidocaine, ice packs and oral medications.
- Topical medications such as antibiotics to treat any infection and resorcinol to unclog follicles and reduce inflammation.
- Oral antibiotics.
- Oral retinoids, usually acitretin, in patients with concurrent acne.
- Adalimumab: a biologic drug that shrinks abscesses and nodules in moderate to severe disease. It can be prescribed to patients 12 years of age and older.
- Intralesional injections of corticosteroids.
- Laser hair removal.
- Surgical procedures such as punch debridement, excision and drainage, wide excision and laser surgery.
Why are wounds not always sutured?
It is not always easy to estimate the exact edges of lesions. If a small remnant of the inflammatory site or scar structure were to remain, it may re-inflame and expand after healing. This is more likely to happen when the surgical wound is closed with sutures, as the rest can be “sutured” as it were. During growth closure, the scar tissue is gradually replaced and any remnants disappear, although even with this technique a relapse cannot be 100% ruled out. This is why we often opt for self-closing healing.
Can the disease be cured?
At this time, there is no known definitive treatment. The disease has multiple causes (genetics, immune system, lifestyle) which can cause new outbreaks later in life. Often the correct combination of drugs and/or operations can achieve long-term disease control (remission).
