Severe Acne Inversa - Dermatosurgical Approach in a Bulgarian Patient


  • Ilia Lozev Medical Institute of Ministry of Interior, Department of General, Vascular and Abdominal Surgery, General Skobelev 79, 1606 Sofia
  • Ivan Pidakev Medical Institute of Ministry of Interior, Department of General, Vascular and Abdominal Surgery, General Skobelev 79, 1606 Sofia
  • Torello Lotti University of Rome “ G. Marconi”, Rome
  • Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden
  • Serena Gianfaldoni University G. Marconi of Rome, Rome
  • Jacopo Lotti Department of Nuclear, Subnuclear and Radiation Physics, University of Rome "G. Marconi", Rome
  • Katlein França Institute for Bioethics & Health Policy; Department of Dermatology & Cutaneous Surgery; Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine - Miami, FL
  • Atanas Batashki Abdominal and Thoracic Surgery, Department of Special Surgery, Medical University of Plovdiv, bul. "Peshtersko shose" Nr 66, 4000 Plovdiv
  • Georgi Tchernev Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia



dermatosurgical approach, invasive approach, hidradenitis suppurativa, acne inversa, treatment outcome, secondary healing


We present a 55-year-old male patient - a smoker, admitted to a Medical Institute of MVR (Ministry of the interior, Sofia, Bulgaria), on occasion of pain and swellings, located in the area of both axillae, accompanied by purulent discharge, with bloody admixtures. Bilateral localised cystic rose above the skin surface, hyperpigmented nodules interconnected with multiple fistulas, was observed within the dermatological examination, resulting in a limitation of the possibility of movement of the hands in all directions. A subjective complaint of pain was obtained on palpation. Solid bilateral axillar cicatrices - formation was also established, which additional impeded the movements of the upper limbs. The disease was generalised affecting additional inguinal, femoral and perineal areas, while at this stage the patient refused categorically eventual photo documentation of them. The diagnosis of acne inversa was made based on the available clinical and para-clinical data, as dual antibiotic therapy with Clindamycin 300 mg, two times per day was initiated for two months, in combination with rifampicin 300 mg, two times per day also for two months. This led to a significant improvement in the clinic symptoms and the patient was hospitalised for radical surgery. A surgical management of the clinical findings was planned by an interdisciplinary team including surgeons and dermatologists. The procedure was performed under general anaesthesia. After a thorough cleaning of the operative field, a radical excision of the lesion in the left axillary and para axillar region was performed, comprising the skin and subcutaneous tissue forward the fascia pectoralis. Tissue was dissected in depth in the form of number 4, thereby creating the conditions for adaptation of the initially encountered communicating with each other skin defects. Two tubular drains were placed, followed by gradual suturing of skin and subcutaneous tissue with final applying of a sterile dressing. Effective medical treatment of patients (as in our case) with severe AI is limited. Adalimumab is the first biological approved for moderate to severe AI but does not result in stable CR (cure rate). Therefore its use in a neoadjuvant setting is under investigation. Wide local excision significantly reduces pain and improves the quality of life of AI patients. While local recurrences rate is low, the satisfaction with the cosmetic results is high. The recurrence rate is dependent on the region affected and the type of surgery. While in the axillary region primary closure may be used to reduce the time to healing, anogenital AI has the lowest recurrence rate of healing by secondary intention.


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How to Cite

Lozev I, Pidakev I, Lotti T, Wollina U, Gianfaldoni S, Lotti J, França K, Batashki A, Tchernev G. Severe Acne Inversa - Dermatosurgical Approach in a Bulgarian Patient. Open Access Maced J Med Sci [Internet]. 2017 Jul. 24 [cited 2023 Jan. 26];5(4):561-3. Available from:

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