Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2019; 11(4): 391-401
Published online Apr 27, 2019. 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
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
Giovanni Damiani, Rosalynn RZ Conic, Department of Dermatology, Case Western Reserve University, Cleveland, OH 44195, United States
Giovanni Damiani, Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo 24100, Italy
Giovanni Damiani, Paolo DM Pigatto, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20100, Italy
Giovanni Damiani, Paolo DM Pigatto, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20161, Italy
Sebastiano Leone, Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
Kristen Fajgenbaum, University of North Carolina School of Medicine, Chapel Hill, NC 27516, United States
Nicola L Bragazzi, School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Gevova 16132, Italy
Alessia Pacifico, San Gallicano Dermatological Institute, IRCCS, Rome 00144, Italy
Carlo Maiorana, Pierpaolo Poli, Center for Jawbone Atrophies Policlinico Hospital, University of Milan School of Dentistry, Milan 20123, Italy
Emilio Berti, 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
Maria C Pace, Marco Fiore, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Piergiorgio Malagoli, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan 20097, Italy
Vincenzo Bettoli, Department of Clinical and Experimental Dermatology, O.C. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara 44121, Italy
Author contributions: Damiani G, Maiorana C, Berti E, Poli P and Bettoli V designed the aim of the study; Damiani G, Pigatto PDM, Poli P and Pacifico A collected data; Damiani G, Fajgenbaum K, Bragazzi NL and Conic RRZ analyzed data; Conic RRZ and Pace MC prepared tables; Damiani G, Pacifico A and Fiore M wrote the manuscript; Fiore M supervised the manuscript; Leone S contributed to the hidradenitis suppurativa antibiotic treatment discussion; all the authors approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Milan Area 2 Ethics Committee (Milan, Italy).
Informed consent statement: Informed consent was obtained from all HS patients after a careful explanation of the nature of the disease and possible complications.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marco Fiore, MD, Doctor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@hotmail.it
Telephone: +39-81-5665180 Fax: +39-81-455426
Received: January 2, 2019
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
Research background

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.

Research motivation

The estimation of NAFLD in HS patients may lead to an early and optimized treatment.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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).

Research perspectives

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.