Increased Prevalence of Metabolic Syndrome in Patients with Acne Inversa

BACKGROUND: Acne inversa (AI; also designated as Hidradenitis suppurativa) is a common chronic inflammatory skin disease, localized in the axillary, inguinal and perianal skin areas that causes painful, fistulating sinuses with malodorous purulence and scars. Several chronic inflammatory diseases are associated with the metabolic syndrome and its consequences including arteriosclerosis, coronary heart disease, myocardial infraction, and stroke. So far, the association of AI with systemic metabolic alterations is largely unexplored. METHODS AND FINDINGS: A hospital-based case-control study in 80 AI patients and 100 age- and sex-matched control participants was carried out. The prevalence of central obesity (odds ratio 5.88), hypertriglyceridemia (odds ratio 2.24), hypo-HDL-cholesterolemia (odds ratio 4.56), and hyperglycemia (odds ratio 4.09) in AI patients was significantly higher than in controls. Furthermore, the metabolic syndrome, previously defined as the presence of at least three of the five alterations listed above, was more common in those patients compared to controls (40.0% versus 13.0%; odds ratio 4.46, 95% confidence interval 2.02 to 9.96; P<0.001). AI patients with metabolic syndrome also had more pronounced metabolic alterations than controls with metabolic syndrome. Interestingly, there was no correlation between the severity or duration of the disease and the levels of respective parameters or the number of criteria defining the metabolic syndrome. Rather, the metabolic syndrome was observed in a disproportionately high percentage of young AI patients. CONCLUSIONS: This study shows for the first time that AI patients have a high prevalence of the metabolic syndrome and all of its criteria. It further suggests that the inflammation present in AI patients does not have a major impact on the development of metabolic alterations. Instead, evidence is given for a role of metabolic alterations in the development of AI. We recommend monitoring of AI patients in order to correct their modifiable cardiovascular risk factors

Increased prevalence of Metabolic Syndrome in patients with Acne inversa

Akne inversa ist eine chronische inflammatorische Hauterkrankung mit klinischen Bildern von Abszessen, Fistelgängen und Narben. Deren typische Lokalisationen sind axillär, inguinal und perianal. Das Metabolische Syndrom wird durch das Vorliegen mindestens dreier von fünf der folgenden Kriterien diagnostiziert: Bauchadipositas, Hypertriglyzeridämie, Hypo-HDL- Cholesterolämie, Hyperglykämie und Hypertonie. Zahlreiche chronisch inflammatorische Erkrankungen, wie zum Beispiel die Hauterkrankung „Psoriasis“ stehen in Zusammenhang mit dem Metabolischen Syndrom bzw. mit dessen Komplikationen wie Arteriosklerose, Herzinfarkt und Schlaganfall. Dies ist die erste Studie zur Häufigkeit des Metabolischen Syndroms bei Patienten mit Akne inversa. Methode: Im Rahmen einer Fall-Kontroll-Studie (single-center) wurden 80 Patienten mit Akne inversa 100 geschlechts- und altersangepassten Kontrollpersonen gegenüber gestellt. Ergebnis: Vier der fünf diagnostischen Kriterien des Metabolischen Syndroms (Bauchadipositas (odds ratio 5,88), Hypertriglyzeridämie (odds ratio 2,24), Hypo-HDL-Cholesterolämie (odds ratio 4,56) und Hyperglykämie (odds ratio 4,09)) waren bei Patienten mit Akne inversa statistisch signifikant häufiger, als bei den Personen der Kontrollgruppe. Damit wurden die Kriterien zur Diagnose des Metabolischen Syndroms bei Patienten mit Akne inversa signifikant häufiger erfüllt, als bei den Kontrollpersonen (40,0% zu 13,0%; odds ratio 4,46). Interessanterweise zeigte die Untersuchung keinen Zusammenhang zwischen Schweregrad und Erkrankungsdauer der Akne inversa und der Anzahl der positiven diagnostischen Kriterien des Metabolischen Syndroms. Außerdem zeigte sich ein überproportional hoher Prozentsatz des Metabolischen Syndroms bei jungen Patienten mit Akne inversa. Zusammenfassung: Diese Studie zeigte zum ersten Mal eine statistisch signifikant erhöhte Häufigkeit des Metabolischen Syndroms bei Patienten mit Akne inversa. Auch waren vier der fünf Diagnosekriterien des Metabolischen Syndroms bei Patienten mit Akne inversa signifikant erhöht. Basierend auf diesen neuen Kenntnissen sollten die Patienten mit Akne inversa optimal im Hinblick auf die Erkrankung des Metabolischen Syndroms untersucht und beraten werden, um weitere Langzeitkomplikationen zu vermeiden bzw. zu reduzieren.Acne inversa or also known as hidradenitis suppurativa is a chronic inflammatory skin disease. Typical lesions are abscesses, fistulas and scars, which affect intertriginous areas, mainly in axillary, inguinal and perianal regions. Many chronic inflammatory diseases such as psoriasis were reported to associate with metabolic syndrome und its complications e. g. arteriosclerosis, coronary heart disease and stroke. The association between acne inversa and metabolic syndrome has not been investigated and reported so far. Methods: This is a single-center case-control study in 80 acne inversa patients and 100 age- and sex-matched control participants. Results: The prevalence of four of diagnostic criteria of metabolic syndrome; central obesity (odds ratio 5.88), hypertriglyceridemia (odds ratio 2.24), hypo-HDL- cholesterolemia (odds ratio 4.56) and hyperglycemia (odds ratio 4.09) in acne inversa patients was significantly higher than in controls. Furthermore, the metabolic syndrome which is diagnosed from the presence of at least three of the five alterations (four listed above and hypertension inclusively), was more common in those patients compared to controls as well (40.0% versus 13.0%; odds ratio 4.46). Interestingly, there was no correlation between the severity and duration of the disease and the levels of diagnostic parameters or the fulfilled numbers of criteria defining the metabolic syndrome. The metabolic syndrome was also observed in a disproportionately high percentage of young acne inversa patients. Conclusions: This study shows for the first time that acne inversa patients have a high prevalence of the metabolic syndrome and four of its total five diagnostic criteria. From these new findings, it is important to recommend proper monitoring and counseling of acne inversa patients in order to modify their metabolic risk factors to prevent long-term complications

Parameter levels and frequency of fulfilled criteria for metabolic syndrome in AI patients and control persons.

<p>(A) The average waist circumference, plasma HDL-cholesterol and TG levels, systolic and diastolic blood pressure, and fasting plasma glucose levels in AI patients and control participants are demonstrated as the mean ± SEM. Significance of differences was assessed by the Mann–Whitney U-test (*<i>P</i><0.05, **<i>P</i><0.01, ***<i>P</i><0.001). (B) The frequency of central obesity, hypo-HDL-cholesterolemia, hypertriglyceridemia, hypertension, hyperglycemia in AI patients and controls are given. Significance of differences was assessed by the Chi-square test (*<i>P</i><0.05, **<i>P</i><0.01, ***<i>P</i><0.001). (C) The percentages of AI patients and controls with metabolic syndrome are given. Significance of differences was assessed by the Chi-square test (**<i>P</i><0.01).</p

Demographic characteristics of AI patients and controls.

<p>The <i>P</i>-values calculated by the Chi-square test (sex distribution) or Mann–Whitney U test (age) are indicated.</p

Correlation of disease severity and duration with parameters of the metabolic syndrome for AI patients.

<p>The correlation of Sartorius scores and duration of AI with each plasma TG levels and the number of positive metabolic syndrome criteria was investigated by Spearman's rank correlation analysis. No significant correlation was found.</p

Correlation of severity and duration of AI with parameters of metabolic syndrome.

<p>The correlation was investigated by Spearman's rank correlation analysis. For each field, the Spearman's rank correlation coefficient and, in parenthesis, the <i>P</i>-values are indicated.</p

Percentages of AI patients and control participants that fulfilled the indicated number of metabolic syndrome criteria.

<p>The dashed vertical line marks the cutoff for the metabolic syndrome.</p

Correlation between age and metabolic syndrome for AI patients and control participants.

<p>(A) The correlation of age with the number of fulfilled metabolic syndrome criteria was investigated by Spearman's rank correlation analysis for AI patients and controls. Significant correlation was found only for controls (Spearman's rank correlation coefficient r_s = 0.363, ***<i>P</i><0.000). (B) The prevalence of the metabolic syndrome in AI patients and control participants in different age groups is given (≤34 years old AI patients: n = 22; ≤34 years old control participants: n = 36; 35 to 44 years old AI patients: n = 27, 35 to 44 years old control participants: n = 23; ≥45 years old AI patients: n = 31; ≥45 years old control participants: n = 41). Significance of differences was assessed by the Chi-square test (*<i>P</i><0.05, ***<i>P</i><0.001).</p

Criteria and parameters of metabolic syndrome in pre-operative and post-operative patients suffering from AI.

<p>The percentages of pre-operative and post-operative patients with pathological alterations (%) and mean ± SD data of the analyzed parameters are shown. The <i>P</i>-values calculated by the Mann–Whitney U-test (for waist circumference, plasma HDL-cholesterol, plasma TG, blood pressure, fasting plasma glucose) or thy Chi-square test (for frequency of central obesity, hypo-HDL-cholesterolemia, hypertriglyceridemia, hypertension, hyperglycemia, and metabolic syndrome) are indicated. Significant <i>P</i>-values (<0.050) are in boldface.</p