The prevalence of metabolic syndrome in patients with hidradenitis suppurativa

doi:10.1016/j.jaad.2013.11.014

Journal of the American Academy of Dermatology

Volume 70, Issue 4, April 2014, Pages 699-703

https://doi.org/10.1016/j.jaad.2013.11.014 Get rights and content

Background

Metabolic syndrome is a multifaceted disorder strongly associated with increased risk for development of cardiovascular disease. Chronic inflammatory diseases have been associated with metabolic syndrome. Hidradenitis suppurativa is a chronic inflammatory skin disease with significant physical and emotional sequelae.

Objective

We sought to investigate a possible association between hidradenitis suppurativa and metabolic syndrome.

Methods

A retrospective chart review of all dermatology clinic encounters over an 18-month period identified 366 patients with an appropriate diagnosis of hidradenitis suppurativa. A control population was created from patients seen in the same clinic during the same time period for the diagnoses of either keloids or verruca vulgaris using the matching criteria of age ±5 years, race, and gender. All participants were examined for characteristics of the metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Program III guidelines.

Results

The prevalence of metabolic syndrome in patients with hidradenitis suppurativa was 50.6%, which was significantly higher than the control group at 30.2% (P < .001).

Limitations

This was a retrospective review. Some participants could not be analyzed for metabolic syndrome presence as a result of missing data points.

Conclusion

Our results indicate that patients with hidradenitis suppurativa may be at high risk for metabolic syndrome.

Section snippets

Methods

This study was approved by the Henry Ford Hospital Institutional Review Board. A retrospective chart review of 39,055 total encounters in the dermatology clinic from January 1, 2011, to May 31, 2012, was performed. Charts of patients with the International Classification of Diseases, Ninth Revision diagnostic code associated with hidradenitis suppurativa were included. In all, 366 patients with an appropriate diagnosis of hidradenitis suppurativa were identified and included in this

Results

The data consist of 366 cases and 366 controls matched on age ±5 years, sex, and race. If a patient was missing data on 3 or more of these factors, they were excluded from the analysis. Among all 738 patients, 465 (243 patients with hidradenitis suppurativa and 222 control subjects) had enough data to determine the presence or absence of metabolic syndrome, which was defined as having 3 or more of the following: obesity, hypertriglyceridemia, low HDL, diabetes mellitus, and hypertension. All

Discussion

Associations between other disorders known to be associated with increased inflammation, such as psoriasis and rheumatoid arthritis, and metabolic syndrome have previously been investigated and are well documented.15, 16, 17, 18, 19, 20, 21, 22, 23, 24 The link between psoriasis and metabolic syndrome has been particularly well established.15, 16, 17 This disease association appears to increase in a dose-responsive manner with the prevalence of metabolic syndrome increased in proportion to the

References (31)

B.G. Vazquez et al.
Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota
J Invest Dermatol
(2013)
J.E. Revuz et al.
Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies
J Am Acad Dermatol
(2008)
I. Cosmatos et al.
Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States
J Am Acad Dermatol
(2013)
S.M. Langan et al.
Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom
J Invest Dermatol
(2012)
C.P. Chung et al.
Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis
Atherosclerosis
(2008)
R. Sabat
IL-10 family of cytokines
Cytokine Growth Factor Rev
(2010)
U.M. Wegenka
IL-20: biological functions mediated through two types of receptor complexes
Cytokine Growth Factor Rev
(2010)
E. Witte et al.
Interleukin-22: a cytokine produced by T, NK and NKT cell subsets, with importance in the innate immune defense and tissue protection
Cytokine Growth Factor Rev
(2010)
C. Schlapbach et al.
Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa
J Am Acad Dermatol
(2011)
B.B. Davidovici et al.
Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions
J Invest Dermatol
(2010)

A. Nikolopoulou et al.

Obesity and metabolic syndrome as related to cardiovascular disease

Expert Rev Cardiovasc Ther

(2012)

H.M. Lakka et al.

The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

JAMA

(2002)

E.S. Ford et al.

Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

JAMA

(2002)

G. Hu et al.

Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women

Arch Intern Med

(2004)

R.B. Ervin

Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006

Natl Health Stat Report

(2009)

Cited by (148)

Therapeutic TNF Inhibitors Exhibit Differential Levels of Efficacy in Accelerating Cutaneous Wound Healing
2024, JID Innovations
Adalimumab but neither etanercept nor certolizumab-pegol has been reported to induce a wound-healing profile in vitro by regulating macrophage differentiation and matrix metalloproteinase expression, which may underlie the differences in efficacy between various TNF-α inhibitors in impaired wound healing in patients with hidradenitis suppurativa, a chronic inflammatory skin disease. To examine and compare the efficacy of various TNF inhibitors in cutaneous wound healing in vivo, a human TNF knock-in Lepr^db/db mouse model was established to model the impaired cutaneous wound healing as seen in hidradenitis suppurativa. The vehicle group exhibited severe impairments in cutaneous wound healing. In contrast, adalimumab significantly accelerated healing, confirmed by both histologic assessment and a unique healing transcriptional profile. Moreover, adalimumab and infliximab showed similar levels of efficacy, but golimumab was less effective, along with etanercept and certolizumab-pegol. In line with histologic assessments, proteomics analyses from healing wounds exposed to various TNF inhibitors revealed distinct and differential wound-healing signatures that may underlie the differential efficacy of these inhibitors in accelerating cutaneous wound healing. Taken together, these data revealed that TNF inhibitors exhibited differential levels of efficacy in accelerating cutaneous wound healing in the impaired wound-healing model in vivo.
Cytochrome P450 Genes Mediated by DNA Methylation Are Involved in the Resistance to Hidradenitis Suppurativa
2023, Journal of Investigative Dermatology
A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa
2023, American Journal of Medicine
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations
2022, Journal of the American Academy of Dermatology
Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.
To provide evidence-based screening recommendations for comorbidities linked to HS.
Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.
Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.
Screening recommendations represent one component of a comprehensive care strategy.
Dermatologists should support screening efforts to identify comorbid conditions in HS.
Hidradenitis suppurativa: Beyond the skin
2022, Piel
La hidradenitis supurativa es una enfermedad inflamatoria crónica y recurrente caracterizada por la aparición de nódulos, fístulas y abscesos dolorosos. En los últimos años se ha incrementado exponencialmente su estudio, entendiendo su naturaleza como un trastorno inflamatorio sistémico. A su vez, puede ocasionar un gran impacto físico y psicosocial. Por ello, el principal objetivo de este estudio es valorar las diversas enfermedades coexistentes en estos pacientes, con la finalidad de realizar un estudio integral de esta enfermedad.
Se realiza un estudio retrospectivo desde octubre de 2015 hasta febrero de 2019, incluyendo a los pacientes seguidos en la Unidad de Hidradenitis del Hospital Universitario Doctor Peset. Se analizan los aspectos epidemiológicos, clínicos y terapéuticos, así como las diversas comorbilidades reflejadas en las historias clínicas de los pacientes.
Se obtienen un total de 210 pacientes. El 62,85% son fumadores, el 61% tienen sobrepeso u obesidad, el 7,4% están diagnosticados de asma bronquial, el 3,8% de los casos tiene fibromialgia y en la historia clínica de 69 pacientes (32,85%) consta el diagnóstico de algún trastorno psiquiátrico.
Diferentes autores sugieren que las comorbilidades descritas en la hidradenitis supurativa pueden ser debido al aumento de la carga inflamatoria cutánea y sistémica. Además de ello, el impacto psicológico que supone podría explicar la mayor prevalencia de los trastornos psiquiátricos en este grupo de pacientes. Por ello, es necesario realizar un manejo integral y multidisciplinar de esta enfermedad, considerando las alteraciones más allá de la piel.
Hidradenitis suppurativa (HS) is an inflammatory chronic disease defined by recurrent nodules, fistulas, and painful abscesses. Its study has been developed exponentially in recent years, and HS is now considered a systemic inflammatory disorder, with a potential physical and psychosocial impact. Therefore, this study aimed to evaluate concurrent comorbidities in patients with HS, to conduct a comprehensive study of this condition.
We performed a retrospective study including patients with HS evaluated at Doctor Peset University Hospital, between October 2015 and February 2019. We analyzed epidemiological, clinical, and therapeutic outcomes, as well as comorbidities described in the patients’ medical records.
We included 210 patients. Of them, 62.85% were smokers, 61% were overweighted or obese, 7.4% had a diagnosis of bronchial asthma, and 3.8% of fibromyalgia. Sixty-nine (32.85%) patients had developed any psychiatric disorder.
Different authors suggest that comorbidities in HS are related to an increased inflammatory load. Moreover, the psychological impact could explain the higher prevalence of psychiatric disorders in HS patients. Thus, a multidisciplinary approach is essential in HS, considering comorbidities beyond the skin.
Comorbidities and Systemic Associations
2022, A Comprehensive Guide to Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) represents a prime candidate to bridge disease of the integument and comorbid systemic disease, possibly owing to its chronic systemic inflammatory state. Indeed, there have been a number of observations involving many organ systems linking comorbid conditions to hidradenitis suppurativa. The global burden of comorbid disease in hidradenitis suppurativa surpasses that seen with psoriasis and it appears similar to other systemic diseases including systemic lupus erythematosus, dermatomyositis, and ankylosing spondylitis. Comorbidities in HS contribute to poor health and impaired quality of life; beyond the significant impact of the disease itself, they appear to also influence overall mortality rates. Attention to comorbid diseases in HS is likely to support health advocacy efforts along with comprehensive care strategies for HS patients.

View all citing articles on Scopus

: The Henry Ford Medical Center Department of Dermatology receives support from and this study was funded by the Livingood Fund and Rodzik Fund, neither of which had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

: Disclosure: Dr Hamzavi has served and/or currently serves as an investigator in clinical trial activities for the following companies: Galderma, ViroXis, Abbvie, La Roche–Posay, Dow, Centocor, Amgen, Clinuvel, and Pfizer. Dr Hamzavi also serves as a consultant for COMBE. Mr Gold, Dr Reeder, and Ms Mahan have no conflicts of interest to declare.

View full text

Original articleThe prevalence of metabolic syndrome in patients with hidradenitis suppurativa

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Methods

Results

Discussion

J Invest Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Invest Dermatol

Atherosclerosis

Cytokine Growth Factor Rev

Cytokine Growth Factor Rev

Cytokine Growth Factor Rev

J Am Acad Dermatol

J Invest Dermatol

Obesity and metabolic syndrome as related to cardiovascular disease

Expert Rev Cardiovasc Ther

The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

JAMA

Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

JAMA

Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women

Arch Intern Med

Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006

Natl Health Stat Report

Original article
The prevalence of metabolic syndrome in patients with hidradenitis suppurativa