What are the associations with hidradenitis suppurativa (HS)?

From the Guidelines

Hidradenitis suppurativa is strongly associated with several comorbid conditions, including obesity, smoking, metabolic syndrome, inflammatory bowel diseases, and mental health disorders, which can significantly impact morbidity, mortality, and quality of life. The most significant associations include obesity, with approximately 75% of patients having elevated BMI, which exacerbates symptoms through increased skin friction and altered hormone metabolism 1. Smoking is another strong association, with up to 90% of patients being current or former smokers, as tobacco may trigger inflammatory pathways and impair wound healing. Metabolic syndrome components, including diabetes, hypertension, and dyslipidemia, frequently co-exist with hidradenitis, and inflammatory bowel diseases, particularly Crohn's disease, share inflammatory pathways with hidradenitis, with 10-20% of patients having both conditions 1. Other associations include polycystic ovary syndrome in women due to hormonal imbalances, depression and anxiety from the chronic pain and social stigma, spondyloarthropathies like ankylosing spondylitis, and follicular occlusion disorders such as acne conglobata and pilonidal disease.

Key Associations

• Obesity: approximately 75% of patients have elevated BMI 1
• Smoking: up to 90% of patients are current or former smokers 1
• Metabolic syndrome: components include diabetes, hypertension, and dyslipidemia 1
• Inflammatory bowel diseases: particularly Crohn's disease, with 10-20% of patients having both conditions 1
• Mental health disorders: depression and anxiety from chronic pain and social stigma 1

Comorbid Conditions

• Polycystic ovary syndrome in women due to hormonal imbalances 1
• Spondyloarthropathies like ankylosing spondylitis 1
• Follicular occlusion disorders such as acne conglobata and pilonidal disease 1
• Cardiovascular disease, hypertension, and dyslipidemia 1

Importance of Comprehensive Evaluation and Management

These associations suggest shared inflammatory mechanisms and highlight the importance of comprehensive evaluation and management of hidradenitis patients beyond skin treatment alone, to improve morbidity, mortality, and quality of life outcomes 1. Screening for comorbid conditions is essential to identify and manage these conditions early, and to reduce the risk of poor health outcomes and negative impact on quality of life 1.

From the FDA Drug Label

Adult Hidradenitis Suppurativa: Adalimumab trough concentrations were approximately 7 to 8 mcg/mL at Week 2 and Week 4, respectively, after receiving 160 mg on Week 0 followed by 80 mg on Week 2. Mean steady-state trough concentrations at Week 12 through Week 36 were approximately 7 to 11 mcg/mL during HUMIRA 40 mg every week treatment Hidradenitis Suppurativa: In subjects with moderate to severe HS, antibodies to adalimumab were associated with reduced serum adalimumab concentrations. Pediatric Hidradenitis Suppurativa: Adalimumab concentrations in adolescent patients with HS receiving the recommended dosage regimens are predicted to be similar to those observed in adult subjects with HS based on population pharmacokinetic modeling and simulation.

The associations with hidradenitis suppurativa (HS) include:

• Pharmacokinetic concentrations: Adalimumab trough concentrations of approximately 7 to 8 mcg/mL at Week 2 and Week 4, and mean steady-state trough concentrations of 7 to 11 mcg/mL during treatment.
• Anti-drug antibody effects: Antibodies to adalimumab are associated with reduced serum adalimumab concentrations in patients with moderate to severe HS.
• Pediatric considerations: Adalimumab concentrations in adolescent patients with HS are predicted to be similar to those in adult subjects with HS. 2

From the Research

Associations with Hidradenitis Suppurativa (HS)

Hidradenitis suppurativa is associated with several comorbidities, including:

• Metabolic disorders, such as obesity and metabolic syndrome 3, 4, 5, 6
• Autoimmune diseases, like inflammatory bowel diseases, autoinflammatory diseases, and spondyloarthritis 3, 4, 5
• Genetic keratin disorders 3
• Skin tumors 3
• Psychiatric diseases, due to the severe effects of HS on self-esteem and quality of life 3, 5
• Cardiovascular disorders, which contribute to reduced life expectancy 5

Systemic Inflammatory Disease

HS is considered a systemic inflammatory disease, with common genetic or environmental factors, or shared inflammatory pathways, contributing to its associations with other conditions 3, 4, 5

Factors Associated with Severe HS

Several factors are associated with severe HS, including:

• Male sex 6
• Smoking, particularly in mild cases 6
• Elevated body mass index (BMI) 6
• High blood pressure 6
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs) 6
• Location of HS lesions, such as the armpits and perianal area 6

Treatment and Management

Treatment of HS often involves a combination of antibiotic therapy, systemic therapies, and lifestyle modifications 4, 5, 7