Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis

Giovanni Damiani; Sebastiano Leone; Kristen Fajgenbaum; Nicola L Bragazzi; Alessia Pacifico; Rosalynn Rz Conic; Paolo Dm Pigatto; Carlo Maiorana; Pierpaolo Poli; Emilio Berti; Maria C Pace; Piergiorgio Malagoli; Vincenzo Bettoli; Marco Fiore

doi:10.4254/wjh.v11.i4.391

Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis

World J Hepatol. 2019 Apr 27;11(4):391-401. doi: 10.4254/wjh.v11.i4.391.

Authors

Affiliations

¹ Department of Dermatology, Case Western Reserve University, Cleveland, OH 44195, United States.
² Division of Infectious Diseases, "San Giuseppe Moscati" Hospital, Avellino 83100, Italy.
³ University of North Carolina School of Medicine, Chapel Hill, NC 27516, United States.
⁴ School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Gevova 16132, Italy.
⁵ San Gallicano Dermatological Institute, IRCCS, Rome 00144, Italy.
⁶ Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20100, Italy.
⁷ Center for Jawbone Atrophies Policlinico Hospital, University of Milan School of Dentistry, Milan 20123, Italy.
⁸ Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan 20122, Italy.
⁹ Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy.
¹⁰ Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan 20097, Italy.
¹¹ Department of Clinical and Experimental Dermatology, O.C. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara 44121, Italy.
¹² Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy. marco.fiore@hotmail.it.

Abstract

Background: 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.

Aim: To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.

Methods: 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.

Results: 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.

Conclusion: HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.

Keywords: End stage liver disease; Hidradenitis suppurativa; Non-alcoholic fatty liver; Non-alcoholic steatohepatitis; Nonalcoholic fatty liver disease.