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), in its two variants non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), is the main cause of End stage liver disease (ESLD) and its complications, including hepatocellular carcinoma (HCC) in North America and Europe. Due to its impact on morbility and mortality, the identification of population with high risk of NAFLD is mandatory and in literature some systemic inflammatory diseases are described to be linked with NAFLD. 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%. No data are present in literature towards the prevalence of NAFLD in HS.
The estimation of NAFLD in HS patients may lead to an early and optimized treatment.
This study aimed first to evaluate the overall prevalence of NAFLD and specifically of NAFL and NASH. Secondary aims were the clinical characterization of these patients. Depict a profile of HS patients with NAFLD will be crucial in optimizing clinical and therapeutic management.
This retrospective multicenter carried out 4 primary dermatological Italian centers started in January 2018 and ended in December 2018. Patients were recruited by filling the recently proposed visual-aided questionnaire for the self- assessment of HS and after underwent a dermatologic visit that evaluate HS with static (Hurley score) and dynamic indexes (ADDI: Autoinflammatory Disease Damage Index, IHS4: International Hidradenitis Suppurativa Severity Scoring System). Transaminases were assessed and all patients underwent liver sonography (US). NASH suspected cases were biopsied.
We included 83 HS patients, in detail 51 patients with HS only and 32 with NAFLD (20 with NAFL, 12 NASH). Inflammatory comorbidities were present in 3.9% of HS only patients, 37.5% of HS/NAFLD, 25% of HS/NAFL patients and 58.3% of HS/NASH patients (P < 0.001). The average IHS4 score among HS/NASH patients (12.7 ± 3.6, P = 0.03) was the highest, while it was similar among those with HS only and HS/NAFL patients (9.6 ± 3.6 and 9.4 ± 3.9 respectively, P = 0.86). Likewise, mean ADDI was significantly higher among HS/NASH patients (5.3 ± 2.2, P < 0.001) compared to HS only and HS/NAFL patients (2.8 ± 1.6 and 2.6 ± 1.4 respectively). While no significant differences were found in Hurley score. There was a significant positive correlation between IHS4 and ADDI scores among all 3 groups (r = 0.7, P < 0.001 for HS only; r = 0.71, P = 0.0004 for HS/NAFL; r = 0.76, P = 0.004 for HS/NASH). Finally, BMI and ADDI were weakly negatively correlated in patients with HS only (r = -0.25, P = 0.05) and in those who had HS and diabetes (r = -0.46, P = 0.04).
HS patients have a high prevalence of NAFLD. In particular clinicians should sonographically assess HS patients with more active disease (high IHS4 score) and with other inflammatory comorbidities (high ADDI).
The present study highlighted the association between HS and NAFLD. However other issues remain still open to future investigations. In particular related issues,that should be addressed to optimize patient management are the prevalence of NAFLD HS-related in different ethnicity and the impact of systemic therapies on NAFLD development in HS patients.