Association of Metabolic Syndrome and Hidradenitis Suppurativa

Abstract

IMPORTANCE An association between the metabolic syndrome (MetS) and chronic inflammatory diseases, such as psoriasis or rheumatoid arthritis, has been suggested.Hidradenitis suppurativa (HS), a more localized chronic inflammation of the skin, has been speculated to have a similar association. Hidradenitis suppurativa is a substantial burden for the individual and a socioeconomic burden globally. Information about the burden of possible comorbidities is scarce.OBJECTIVE To investigate the possibility of an association between HS and MetS.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional population- and hospital-based study of HS and MetS.We identified 32 patients with physician-verified HS from the outpatient clinic at the Department of Dermatology, Roskilde Hospital, and 326 patients with HS and 14 851 individuals without HS from the general population. Individuals with HS were younger,predominantly female, and more often smokers compared with the non-HS group.EXPOSURE Hidradenitis suppurativa.MAIN OUTCOMES AND MEASURES Metabolic syndrome and its components of diabetes mellitus, hypertension, dyslipidemia, and obesity.RESULTS When compared with the non-HS group, the odds ratios (ORs) for the hospital HS and population HS groups were 3.89 (95%CI, 1.90-7.98) and 2.08 (95%CI, 1.61-2.69),respectively, for MetS; 5.74 (95%CI, 1.91-17.24) and 2.44 (95%CI, 1.55-3.83), respectively, for diabetes mellitus; 6.38 (95%CI, 2.99-13.62) and 2.56 (95%CI, 2.00-3.28), respectively, for general obesity; and 3.62 (95%CI, 1.73-7.60) and 2.24 (95%CI, 1.78-2.82), respectively, for abdominal obesity. With regard to dyslipidemia, significant results were found for decreased levels of high-density lipoprotein cholesterol, with ORs of 2.97 (95%CI, 1.45-6.08) and 1.94(95%CI, 1.52-2.48) for the hospital HS and general population HS groups, respectively, when compared with the non-HS group. With regard to increased triglyceride levels, only the result for the population HS group compared with the non-HS group was significant, with an OR of1.49 (95%CI, 1.18-1.87). The OR for hypertension, which was only significant for the hospital HS group compared with the non-HS group, was 2.14 (95%CI, 1.01-4.53). Obesity and inflammation acted as possible confounders. The ORs were higher for the hospital HS group compared with the population HS group. The association between HS and MetS was not influenced by the degree of HS severity.CONCLUSIONS AND RELEVANCE As with more systemic inflammatory diseases, HS appears to be associated with MetS, indicating substantial comorbidities. Because this study is cross-sectional, causality remains to be explored.

Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review

“…Literature is constantly enriched by surveys showing the complex yet established link between the metabolic syndrome and HS [63,64,65,66,67]. Consequently, comorbidities and metabolic alterations associated with HS include overweight, obesity, diabetes, insulin resistance, glucose intolerance, hyperlipidemia [64,65,66,68,69,70], as well as dysregulated adipokine levels [32,71], which may all be possible modulators of disease activity (e.g., obesity is related to increased levels of proinflammatory circulating cytokines TNF-α and IL-1β secreted by visceral fat macrophages [13,72]; insulin resistance, which is strongly linked to obesity, is aggravated by TNF-α-IKKβ-mediated inhibitory phosphorylation of insulin receptor substrate-1 [73], etc.).…”

An Update on Medical Treatment Options for Hidradenitis Suppurativa

“…After a decrease in BMI of 15 %, half of the patients stated they were free of inflammation and another 20 % reported to have fewer symptoms [140]. Since HS is also associated with the metabolic syndrome [141], patients with HS should be strongly advised to reduce weight.…”

Vitiligo and quality of life: the dark face of whiteness

“…The only limitation of the present study is that the authors chose to use a generic questionnaire (Skindex-29) rather than a vitiligo-specific questionnaire such as the Vitiligo Impact Patient scale 3 or the VITIQoL, 4 which reflect better patient expectations and have the advantage of covering all aspects of the burden of vitiligo in daily life. To conclude, the study by Bae et al 2 is an important step towards confirming the impact of vitiligo on patient QoL.…”

“…1 In this issue of the BJD, Bae et al conducted a nationwide questionnaire-based study on QoL in patients with vitiligo. 2 The main aim of this study was to identify the risk factors associated with impairment of QoL. For this purpose, 1123 patients with vitiligo were recruited from 21 hospitals in Korea from July 2015 to June 2016.…”

“…1 Since the introduction of biologics to the therapy of psoriasis in 2003, overall 14 national and international registers have been established worldwide, most of which are located in Europe. 2 The main objectives of these registers are to (i) gather data on the demographics and clinical characteristics of the psoriasis patient population; (ii) monitor safety and real-world effectiveness of conventional and biological systemic treatments, drug survival, predictors of response and treatment patterns; and (iii) provide long-term data on treatment in terms of disease activity and health-related quality of life (HRQoL). 2 In this issue of the BJD Hjalte et al 3 report on their observational study of 583 patients from the Swedish National Psoriasis Register (PsoReg).…”