Kosmetische Medizin 6-2010: 294 – 297

Acne inversa and acne conglobata – ablation of inflammatory
infiltrates and scar correction using a CO2 Laser

CHRISTIAN HEINEMANN UND ADRIAN KRÄHENBÜHL

KEY WORDS: Acne inversa, acne conglobata, neck and décolleté involvement, carbon dioxide laser, infliximab

SUMMARY:
Acne inversa and acne conglobata are two strongly related chronic relapsing inflammatory skin diseases which are part of the follicular occlusion tetrad. In spite of the big bundle of therapeutic approaches, a satisfying treatment algorithm is lacking. We present a patient suffering from acne conglobata and acne inversa Hurley grade III. Additionally to severe involvement of the predilection sites of acne inversa (inguinal, anogenital and perineal folds and armpits) he shows large confluent inflammatory plaques at neck, face and décolleté. Isotretinoine, Infliximab and antibiotic treatment with clindamycine and rifampicine did not lead to improvement. Wide excision of attained glands in the anogential and inguinal area led to complete remission in the treatment area without further relapse. A large inflammatory plaque at the neck was treated with the carbon dioxide laser with good result. Disease control was achieved with minocycline 50 mg twice daily, topical erythromycine and topical tacrolimus. Disfiguring, rope ladder shaped scars with comedones were ablated in another carbon dioxide laser session. This severe case shows that acne conglobata and acne inversa can be devastating diseases. The carbon dioxide laser is an appropriate tool for treatment of inflammatory lesions as well as for improving the appearance of scarred residues.

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