Inflammatory bowel disease is associated with hidradenitis suppurativa: Results from a multicenter cross-sectional study

doi:10.1016/j.jaad.2016.08.031

Journal of the American Academy of Dermatology

Volume 76, Issue 1, January 2017, Pages 49-53

https://doi.org/10.1016/j.jaad.2016.08.031 Get rights and content

Background

Hidradenitis suppurativa (HS) is often associated with inflammatory bowel disease (IBD; Crohn's disease or ulcerative colitis). However, the prevalence of IBD in HS patients is unknown.

Objective

To determine the prevalence of IBD in HS patients, and determine if patients with HS and IBD have a distinct HS phenotype.

Methods

For this multicenter, cross-sectional study, HS patients were asked during their first consultation if they had IBD. The diagnosis of IBD was checked in the medical files, and clinical characteristics were collected.

Results

IBD had a prevalence of 3.3% (95% CI 2.3-4.4) in 1076 HS patients. The prevalence of Crohn's disease was 2.5% (95% CI 1.6-3.4) and the prevalence of ulcerative colitis was 0.8% (95% CI 0.3-1.4). HS-IBD patients were less frequently obese (13.9% vs 31.2%, P = .04) than HS-only patients, but there were no differences in gender, family history of HS, disease severity, body areas affected by HS, or smoking status.

Limitations

The prevalence might be underestimated since HS patients might still develop IBD.

Conclusion

The prevalence of IBD in HS patients (3.3%) is 4-8 times higher than the prevalence in the general northern European population (0.41%-0.74%), however HS-IBD patients do not have a distinct HS phenotype.

Section snippets

Patients

For this multicenter, cross-sectional study, data were collected between 2007 and 2015 from HS patients who visited the Departments of Dermatology at Erasmus Medical Center Rotterdam, The Netherlands (ID, HZ, EP), Deventer Hospital, The Netherlands (JB), University Medical Center Groningen, The Netherlands (MK, BH), and Hôpital Erasme, Belgium (FB, VM). For this type of analysis, medical ethical committee approval is not required under Dutch law.

Data collection

During the initial consultation, HS patients were

Results

Data were collected from a total of 1076 HS patients, 324 males (30.1%) and 752 females (69.9%), with a mean age of 38.4 ± 12.7 years. Most patients had Hurley stage I (43.9%) or stage II (44.2%) and suffered from HS for a median period of 11.0 years (IQR: 5.0-21.0) (Table I).

Discussion

This multicenter cross-sectional study shows that 36 out of 1076 HS patients (3.3%) had IBD, resulting in a prevalence of 2.5% for CD and 0.8% for UC in HS patients. In comparison, the estimated prevalence of IBD in the general population in northern Europe ranges between 0.41% and 0.74%, with a prevalence of CD between 0.14% and 0.32% and a prevalence of UC between 0.24% and 0.41%.7, 8, 9, 10 These data indicate that the prevalence of IBD is 4-8 times higher in our HS cohort than in the

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What should a surgeon know about hidradenitis suppurativa?
2023, Journal of Visceral Surgery
Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
Epidemiology of hidradenitis suppurativa
2023, Clinics in Dermatology
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disease affecting hair follicles in predominantly intertriginous areas, characterized by deep, painful nodules and abscesses, fistulas, sinus tracts, and scarring. The estimated global prevalence of HS is highly variable, as revealed in a growing body of published literature, and ranges from 0.053% to 4.1%. In North American and European patients, HS is three times more common in women than men, whereas in South Korea and Japan, male predominance is found. The disease most frequently manifests itself between the ages of 18 and 29. Numerous published studies have reported the association between smoking, obesity, and HS, although there are limitations in confirming the causal relationship due to the retrospective design of the available studies.
Case-control studies have frequently evaluated the association between HS, metabolic syndrome, and other systemic comorbidities. Due to increased mental health problems, a higher risk of suicide in patients with HS has been reported. We provide up-to-date evidence about the epidemiology, genetic and environmental risk factors, comorbidities, and quality of life of patients with HS. The divergence in HS frequency, possibly due to differences in populations and methodologies, remains to be explained in future worldwide studies.
Neutrophilic granulocyte-derived B-cell activating factor supports B cells in skin lesions in hidradenitis suppurativa
2023, Journal of Allergy and Clinical Immunology
Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful inflamed nodules, abscesses, and pus-draining tunnels appearing in axillary, inguinal, and perianal skin areas. HS lesions contain various types of immigrated immune cells.
This study aimed to characterize mediators that support lesional B/plasma cell persistence in HS.
Skin samples from several cohorts of HS patients and control cohorts were assessed by mRNA sequencing, quantitative PCR on reverse-transcribed RNA, flow cytometry, and immunohistofluorescence. Blood plasma and cultured skin biopsy samples, keratinocytes, dermal fibroblasts, neutrophilic granulocytes (neutrophils), monocytes, and B cells were analyzed. Complex systems biology approaches were used to evaluate bulk and single-cell RNA sequencing data.
Proportions of B/plasma cells, neutrophils, CD8⁺ T cells, and M₀ and M₁ macrophages were elevated in HS lesions compared to skin of healthy and perilesional intertriginous areas. There was an association between B/plasma cells, neutrophils, and B-cell activating factor (BAFF, aka TNFSF13B). BAFF was abundant in HS lesions, particularly in nodules and abscesses. Among the cell types present in HS lesions, myeloid cells were the main BAFF producers. Mechanistically, granulocyte colony-stimulating factor in the presence of bacterial products was the major stimulus for neutrophils’ BAFF secretion. Lesional upregulation of BAFF receptors was attributed to B cells (TNFRSF13C/BAFFR and TNFRSF13B/TACI) and plasma cells (TNFRSF17/BCMA). Characterization of the lesional BAFF pathway revealed molecules involved in migration/adhesion (eg, CXCR4, CD37, CD53, SELL), proliferation/survival (eg, BST2), activation (eg, KLF2, PRKCB), and reactive oxygen species production (eg, NCF1, CYBC1) of B/plasma cells.
Neutrophil-derived BAFF supports B/plasma cell persistence and function in HS lesions.
Hidradenitis suppurativa and inflammatory bowel disease in a nested case-control study
2023, Digestive and Liver Disease
Citation Excerpt :
Even though obesity is a known risk factor for HS [8,9], IBD patients are known to be at higher risk of malnutrition, due to chronic systemic inflammation and possible malabsorption, thus possibly accounting for this finding. Moreover, the observed lower frequency of obesity in HS patients with IBD is consistent with a multicenter cross-sectional study from Deckers et al. [20], including 36 IBD-HS patients and 1040 HS patients with no IBD. Differently, in our cohort, no difference was observed in terms of mean BMI in Cases vs Controls, but only in terms of frequency of obesity.
Association between Hidradenitis Suppurativa (HS) and Inflammatory Bowel Disease (IBD) has been suggested.
To assess characteristics of HS and IBD in patients with or without concomitant IBD.
In a prospective, nested case-control study, each IBD patient with concomitant HS (Case) was retrospectively matched with 4 patients with HS and no IBD (Controls) for gender and age (±5 years).HS was classified according to the Hurley score and the International Hidradenitis Suppurativa Severity Score System (IHS4). Data were expressed as mean (Standard Deviation). Statistical analysis included Student-t Test or Mann-Whitney Test, χ2 test, univariate and multivariate logistic regression.
The study population included 125 patients with HS: 25 with IBD, 100 matched Controls with no IBD. IBD group included 19 (76%) Crohn's disease and 6 (24%) Ulcerative Colitis patients. Obesity, familial HS and perianal HS were less frequent in Cases than in Controls (1[4%] vs 25(25%];p = 0.02; 1[4%] vs 21(21%];p = 0.04; 1[4%] vs 31(31%];p = 0.005, respectively).HS was less severe in Cases when assessed by the IHS4 (5.9 ± 4 vs 9 ± 6.7;p = 0.04).Complete drug-induced response for HS was more frequent in IBD (13[53%] vs28 (28%]; p = 0.04).
Clinical characteristics of HS and of patients differed between Cases and Controls. Present findings suggest the need to appropriately search and assess skin lesions compatible with HS in IBD.
Insights into hidradenitis suppurativa
2022, Journal of Allergy and Clinical Immunology
Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. A complex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate in vitro and animal models.
Targeted Therapeutics: Biologics, Small Molecules
2022, A Comprehensive Guide to Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by inflammatory nodules and sinus tracts involving intertriginous areas. Historically, antibiotic and surgical treatments were the mainstay of HS therapy, but in the last decade a growing number of biologic therapies which modulate the inflammatory pathways of HS have become available and have been investigated for treatment of moderate-to-severe HS. Adalimumab, an injectable tumor necrosis factor (TNF)-α inhibitor, is the only FDA-approved medication for the disease, yet approximately half of patients have an inadequate response. For these patients, an alternative TNF-α inhibitor, infliximab, may be successful, particularly if infused at higher dose and frequency (7.5 to 10 mg/kg every 4 to 6 weeks). For those who cannot tolerate or do not respond to anti-TNF therapy, anti-IL1, anti-IL17, and anti-IL12/23 inhibitors may be appropriate, depending on patient factors and comorbidities. New medications are in development, which may provide additional options for those who remain refractory to existing targeted therapies.

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: Drs Benhadou and Koldijk contributed equally to this work.

: Funding sources: None.

: Disclosure: B Horváth performed investigator-initiated studies of Janssen Cilag BV (The Netherlands) and AbbVie Inc; she received an unrestricted educational grant from AbbVie Netherlands (The Netherlands). Further, she has acted as a consultant for AbbVie and Janssen-Cilag. EP Prens has acted as a consultant for AbbVie, Amgen, Astra-Zeneca, Baxter, Eli Lilly, Idera, Galderma, Janssen-Cilag, Novartis, NTRC, and Pfizer and has received investigator-initiated research grants from Pfizer, Janssen-Cilag, and AbbVie. J Boer is on the advisory board of AbbVie Inc. F Benhadou has received honoraria from AbbVie Inc for participating in the advisory board. HH van der Zee has received honoraria from AbbVie Inc for participating in the advisory board.

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Original articleInflammatory bowel disease is associated with hidradenitis suppurativa: Results from a multicenter cross-sectional study

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Patients

Data collection

Results

Discussion

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc

J Crohn's Colitis

J Am Acad Dermatol

Hidradenitis suppurativa

J Eur Acad Dermatol Venereol

Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study

Br J Dermatol

Identification of clinical and genetic parameters associated with hidradenitis suppurativa in inflammatory bowel disease

Inflamm Bowel Dis

The prevalence of hidradenitis suppurativa in 1093 patients with inflammatory bowel disease

Br J Dermatol

Prevalence of inflammatory bowel disease: estimates for 2010 and trends in Germany from a large insurance-based regional cohort

Scand J Gastroenterol

Nationwide prevalence of inflammatory bowel disease in Sweden: a population-based register study

Aliment Pharmacol Ther

Inflammatory bowel disease: epidemiology and management in an English general practice population

Aliment Pharmacol Ther

Original article
Inflammatory bowel disease is associated with hidradenitis suppurativa: Results from a multicenter cross-sectional study