Familial hidradenitis suppurativa tied to metabolic disease

A recent meta-analysis underscores the increased risk of cardiovascular and metabolic comorbidity in patients with familial hidradenitis suppurativa (HS). This association may shift clinical practices towards integrating cardiovascular risk assessments into the routine care of patients with a hereditary predisposition to HS.

HS is a complex inflammatory skin disease and the molecular pathogenesis of the disease is incompletely understood [1]. In general, there is a higher risk of metabolic and cardiovascular diseases in TNF-α/IL-17-driven diseases like psoriasis, which are known to be linked to cardiovascular comorbidities. Thus, Dr Suzan Al-Gburi (University Hospital Cologne, Germany) and colleagues were interested in the role of a positive family history in patients with HS regarding these comorbidities [2].

They performed a meta-analysis of 2 German studies, the EpiCAi and the BATMAN studies, including 236 participants with HS. Among these, 25.8% had a positive family history of HS, while the rest were sporadic cases. “Interestingly, the age of onset was significantly earlier in cases with familial predisposition, while the diagnosis was made markedly later [about 4 years compared with those without familial predisposition],” Dr Al-Gburi said.

Despite familial cases demonstrating slightly less severe disease activity, the risk for metabolic disease was profoundly higher in these patients. Specifically, the odds ratios for hyperlipidaemia, cardiovascular diseases, and diabetes mellitus were 2.36, 2.99, and 1.76, respectively, when compared with participants with sporadic HS​. “Having at least one of the diseases mentioned above had an odds ratio of 2.27. This implies that there is a more than doubled risk of patients with a positive family history suffering from metabolic disease,” Dr Al-Gburi said. These increased risks were independent of common risk factors such as smoking and body mass index, suggesting an inherent link between familial HS and metabolic syndrome.

The study underscored the need for specialised cardiovascular monitoring and earlier intervention in patients with familial HS. Earlier diagnosis and tailored management, particularly for cardiovascular and metabolic comorbidities, could significantly improve long-term outcomes for this patient population.

1. 
   
   1. Kozera EK. Dermatol Rev 2022;DOI:10.1002/der2.113.
   2. Al-Gburi S, et al. Familial occurrence of hidradenitis suppurativa is associated with increased risk of metabolic syndrome. Abstract 7997, EADV Congress 2024, 25–28 September, Amsterdam, the Netherlands.

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Posted on 6 November 20246 November 2024