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
Processing time: 114 Days and 14.4 Hours
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: Non-alcoholic steatohepatitis; Non-alcoholic fatty liver; Nonalcoholic fatty liver disease; End stage liver disease; Hidradenitis suppurativa

Core tip: Nonalcoholic fatty liver disease (NAFLD), in its two variants non-alcoholic fatty liver and non-alcoholic steatohepatitis, is often linked to systemic inflammatory conditions, such as psoriasis. Remarkably, 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%. Furthermore, HS patients display a significant comorbidities burden (e.g., cardiovascular risk, metabolic syndrome, diabetes, and spondyloarthritis) but the association with NAFLD was not previously investigated. This is the first study which evaluated NAFLD prevalence and its characteristics in HS patients.