The Last Metamorphosis of Verneuils Disease

In 1956, Pillsbury, Shelley, and Kligman brought together acne conglobata, hidradenitis suppura-tiva, and dissecting cellulitis of the scalp [32] under the name follicular occlusion triad [33], whose common feature was a tendency to fol-licular hyperkeratinization leading to the retention of keratin products with secondary bacterial infection.

In 1975, Plewig and Kligman [34] added pilo-nidal sinus to the triad and proposed the term acne tetrad, pointing out the absence of apo-crine involvement in hidradenitis suppurativa. More recently, Plewig and Steger proposed designating entities previously named acne triad or tetrad as acne inversa [35].

The fundamental change in acne inversa is the hyperkeratosis of the infundibulum as in acne vulgaris [36]. The authors denied that ec-crine or apocrine sweat glands are involved in the pathogenesis of acne inversa. The involvement of sweat glands was regarded as secondary only. More recently, studies have shown that acne inversa is a defect of the terminal follicular epithelium. According to these authors [36], the association of acne inversa with many disorders in which poral occlusion is prominent gives credit to the follicular origin of acne inversa. They insisted that it was necessary to abandon the term hidradenitis suppurativa [37].

As for Verneuil, the original eponym of this long and confused history, he seems abandoned.

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