Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.391
Peer-review started: January 4, 2019
First decision: January 23, 2019
Revised: February 25, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 27, 2019
Nonalcoholic fatty liver disease (NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease (ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern. Hidradenitis suppurativa (HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.
To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.
This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.
Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients (P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index (ADDI) was significantly higher among patients with HS/NASH (5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only (2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.
HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.
Core tip: Nonalcoholic fatty liver disease (NAFLD), in its two variants non-alcoholic fatty liver and non-alcoholic steatohepatitis, is often linked to systemic inflammatory conditions, such as psoriasis. Remarkably, hidradenitis suppurativa (HS) is a new affirming systemic inflammatory disorder of the follicular epithelium of skin apocrine glands with a prevalence in normal population ranging from 0.05% to 4.10%. Furthermore, HS patients display a significant comorbidities burden (e.g., cardiovascular risk, metabolic syndrome, diabetes, and spondyloarthritis) but the association with NAFLD was not previously investigated. This is the first study which evaluated NAFLD prevalence and its characteristics in HS patients.