Viewpoint 6

Visfatin and insulin levels and cigarette smoking are independent risk factors for hidradenitis suppurativa: a case-control study

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. HS has been associated with obesity, adipokine imbalance, dyslipidemia, pro-inflammation, and metabolic syndrome (MS). The aim of this study was to determine the association between HS, and serum visfatin levels (SVLs), small-dense low-density lipoprotein cholesterol (sdLDL-C), and ischemia-modified albumin (IMA), as well as the association between HS, and smoking, alcohol consumption, anthropometric measurements, blood pressures (BPs), fasting blood glucose (FBG) and lipids, inflammatory markers, homocysteine, uric acid (UA), serum insulin levels (SILs), insulin resistance (IR) and MS, so as to identify relevant risk factors for HS. This case-control study included 40 patients (M/F: 23/17) and 40 age- and gender-matched controls (M/F: 23/17). Demographic data, smoking status and alcohol consumption, personal and family medical history, previous and current treatments were noted. Anthropometric data, BPs, FBG and lipids, homocysteine, UA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and high-sensitivity CRP (hs-CRP), hemoglobin A1c (HbA1c), SILs, SVLs, IMA and sdLDL-C were measured. Homeostasis model assessment for IR (HOMA-IR) was calculated. The associations were made by univariate and multivariate analyses. Univariate analysis showed that there was a significant association between HS and smoking, pack-years of smoking, weight, body mass index (BMI), waist circumference (WC), triglycerides (TGs), high-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, SILs, CRP, hs-CRP, homocysteine, UA, ESR, HOMA-IR, SVLs, and MS. After adjusting for BMI and smoking status, the SVLs, SILs, and hs-CRP levels remained higher in the patients than in the controls (P = 0.02, P = 0.01, and P = 0.02, respectively). Multivariate analysis showed that there was a significant association between HS, and the SVLs and SILs, and smoking. Each unit increase in the SVL (P = 0.003, 95% CI 1.16-2.11) and SIL (P = 0.03, 95% CI 1.01-1.17) increased the risk of HS 1.56- and 1.09-fold, respectively. Furthermore, smoking was associated with a 14.87-fold increase in the risk of HS (P = 0.001, 95% CI 2.82-78.56). This study indicates that HS patients have higher SVLs, SILs, and hs-CRP levels than healthy controls-independent of BMI and smoking status. The SVL and SILs and smoking were independent risk factors for HS.

Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A

BACKGROUND

The relationship between tobacco use and hidradenitis suppurativa (HS) is controversial.

OBJECTIVES

To determine the incidence of HS among tobacco smokers.

METHODS

Retrospective cohort analysis identifying incident HS cases among adult tobacco smokers and nonsmokers sampled from a demographically heterogeneous population-based sample of over 50 million unique patients across all census regions in the U.S.A.

RESULTS

We identified 3 924 310 tobacco smokers, which included 7860 patients newly diagnosed with HS. Tobacco smokers diagnosed with HS were most commonly aged 18-39 years (3795 of 7860; 48·3%), women (5640 of 7860; 71·8%), white (5200 of 7860; 66·2%) and those with body mass index (BMI) ≥ 30 (5690 of 7860; 72·4%). Overall incidence of HS was 0·20% (7860 of 3 924 310) among tobacco smokers and 0·11% (8430 of 8 027 790) among nonsmokers (P < 0·001). Incidence was greatest among tobacco smokers who were aged 30-39 years (0·35%), women (0·28%), African Americans (0·46%) and those with BMI ≥ 30 (0·33%). The overall adjusted odds of developing HS was 1·90 (95% confidence interval 1·84-1·96) among tobacco smokers, compared with nonsmokers (P < 0·001). HS incidence among tobacco smokers remained increased within each demographic subgroup.

CONCLUSIONS

Incidence of HS appears to be doubled among tobacco smokers. These findings may support evidence-based counselling efforts for the cessation of smoking in populations at risk for HS.

Hidradenitis suppurativa in children and adolescents: a review of treatment options

Hidradenitis suppurativa (HS) is a burdensome disease and has the potential to affect the life course of patients. It is a rare disease in children, and the recorded literature is correspondingly scarce. This article reviews the therapeutic options for HS in children and adolescents, and highlights particular differences or challenges with treating patients in this age group compared with adults. The work-up of paediatric patients with HS should include considerations of possible endocrine co-morbidities and obesity. Medical therapy of lesions may include topical clindamycin. Systemic therapy may include analgesics, clindamycin and rifampicin, finasteride, corticosteroids or tumour necrosis factor alpha (TNFα) blockers. Superinfections should be appropriately treated. Scarring lesions generally require surgery.