|Risk factors for hidradenitis suppurativa: a pilot study.|
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|PMID: 23197222 Owner: NLM Status: In-Data-Review|
|The hidradenitis suppurativa is a chronic debilitating inflammatory disease whose etiology is not fully understood. We conducted a pilot case-control study matched by sex and age with other dermatological patients to analyze possible risk factors associated with this disease. We included 15 cases and 45 controls, 67% were women. Bivariate and multivariate logistic regression analysis identified significant association with smoking, higher body mass index and family history. The use of hormonal contraceptives was less frequent in women with hidradenitis.|
|Juliano Vilaverde Schmitt; Giovana Bombonatto; Manoela Martin; Hélio Amante Miot|
|Type: Journal Article|
|Title: Anais brasileiros de dermatologia Volume: 87 ISSN: 1806-4841 ISO Abbreviation: An Bras Dermatol Publication Date: 2012 Dec|
|Created Date: 2012-11-30 Completed Date: - Revised Date: -|
Medline Journal Info:
|Nlm Unique ID: 0067662 Medline TA: An Bras Dermatol Country: Brazil|
|Languages: eng Pagination: 936-8 Citation Subset: IM|
|dermatology service, Hospital Universitário Evangélico de Curitiba, Faculdade Evangélica do Paraná, Curitiba, PR, Brazil.|
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Journal ID (nlm-ta): An Bras Dermatol
Journal ID (iso-abbrev): An Bras Dermatol
Journal ID (publisher-id): An. bras. dermatol.
Publisher: Sociedade Brasileira de Dermatologia
http://www.anaisdedermatologia.org.brhttp://www.scielo.br/abd©2012 by Anais Brasileiros de Dermatologia
Received Day: 01 Month: 4 Year: 2012
Accepted Day: 15 Month: 5 Year: 2012
Print publication date: Season: Nov-Dec Year: 2012
Volume: 87 Issue: 6
First Page: 936 Last Page: 938
PubMed Id: 23197222
|Risk factors for hidradenitis suppurativa: a pilot study*|
|Juliano Vilaverde Schmitt1|
|Hélio Amante Miot4|
1Dermatologist - Preceptor of the dermatology service of the Hospital
Universitário Evangélico de Curitiba - Faculdade Evangélica do
Paraná (HUEC-FEPAR) - Curitiba (PR), Brazil
2Resident physician in internal medicine - Hospital Universitário
Evangélico de Curitiba - Faculdade Evangélica do Paraná
(HUEC-FEPAR) - Curitiba (PR), Brazil
3Trainee physician - Fundação Pró-Hansen (FPH) -
Curitiba (PR), Brazil
4PhD Professor - PhD; assistant professor of the Dermatology and
Radiotherapy Department of the Universidade Estadual Paulista "Julio de Mesquita
Filho" (UNESP) - Botucatu (SP), Brazil
|Correspondence: Mailing address: Juliano Vilaverde Schmitt, Av. Sete de Setembro, 4713,
80240-000 - Batel. Curitiba, PR, E-mail: firstname.lastname@example.org
The hidradenitis suppurativa (HS) is a chronic inflammatory disease, with a recurrent character and difficult to treat. It is believed to result firstly from the occlusion of the hair follicle, followed by secondary infection of the apocrine glands.1-5
Women are about four times more affected than men, and, since apocrine glands only begin their secretory activity in puberty, the disease usually begins after that period, mainly affecting areas rich in glands such as the axillary regions, inguinal, perineal, intergluteal, perianal and inframammary. 1-5
Although its etiology is not fully elucidated, some risk factors have been described in the literature, albeit controversial. We emphasize obesity, use of hormonal contraceptives (HC), smoking and diabetes. We found no Brazilian studies that have evaluated these risk factors in our population, much less in a multivariate analysis or controlled by dermatology patients.6
We conducted a case-control study matched by sex and age in the proportion of one case to three controls. We interviewed patients with hidradenitis suppurativa treated between 2008 and 2009 at a public clinic of dermatology, according to a standardized questionnaire. Controls were selected from patients attended in the same institution with others dermatologic problems at the same period. Data were compared in a bivariate and multivariate conditional logistic regression. We considered significant p values <0.05.
We included 15 cases and 45 controls, 67% were women. The current average age was 32.3 ± 11.6 years, with an age at onset of 20.6 ± 12.3 years. Nine patients had lesions in the armpits and 9 had lesions in the groin or genital area. One had inframammary lesions. Ten reported active disease in the last two months and 5 had undergone surgical drainage or excision.
Six patients reported a similar condition in first-degree relatives. Skin diseases more frequent in controls were dyschromia, acne, seborrheic dermatitis and leprosy.
In bivariate analysis, HS patients had higher smoking history, family history compatible with HS and higher BMI. Women with HS less frequently used HC (Table 1).
In multivariate analysis, we identified significant association with family history of HS, highest daily consumption of cigarettes and the interaction between body mass index (BMI) and age (Table 2). Among the cases there was a significant correlation between BMI and age at onset (Pearson R 2 = 0.65 / p <0.01).
Our data show age distribution, gender, and age at onset of the disease very similar to the literature. Likewise, the skin diseases present in the controls are compatible with the nosology of this age in our institution.4,5
The data reinforce the observations of other studies in terms of the association of HS with smoking and family history.7
Our data suggest a protective role of the use of HC. Similarly, recent work has verified the superiority of hormonal treatment when compared to other treatments such as antibiotics.8
Confirming previous studies, we identified elevated BMI as a risk factor for HS. However, in our data, BMI seemed to correlate with age at onset, suggesting that obesity should act as a risk factor especially among older patients. The association with obesity could be reflected in findings of insulin resistance, but the small sample size and the non performing of laboratory tests limited such observations.6
The family history of HS was a significant risk factor, as seen in several studies, some of which describe syndromic patterns with great genetic penetrance. However, we cannot rule out recall bias.9,10
Because this was a pilot study, this paper presents as the main limitation the small sample size. On the other hand, the pairing of the controls strengthens the results.
We conclude that the present study revealed risk factors previously reported in the literature regarding hidradenitis suppurativa, reinforcing the role of smoking, obesity and genetic susceptibility. The data suggest that regular use of HC could prevent the development or persistence of HS in women, but larger studies should be performed.
Conflict of interest: None
Financial funding: None
fn01* Work performed at the Dermatology Service of the Hospital Universitário Evangélico de Curitiba - Faculdade Evangélica do Paraná (HUEC-FEPAR) - Curitiba (PR), Brazil.
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Bivariate analysis of characteristics, according to the groups with (cases) and without (controls) hidradenitis suppurativa (N = 60)
|Variables||All (N=60)||Cases (N=15)||Controls (N=45)||Odds Ratio (confidence interval 95%)||p|
|Current age (years)*||31,7±11,3||32,3±12,0||31,4±11,3||0,78|
|Body mass index*||24,7±4,6||26,9±5,9||24,0±4,0||-||<0,05|
|Hormonal contraceptives - women**||11 (31%)||0 (0%)||12 (40%)||-||0,02|
|Family history of hidradenitis suppurativa **||9 (15%)||6 (40%)||3 (7%)||9,33 (1,96 to 44,49)||<0,01|
|Smoking history**||23 (38%)||9 (60%)||14 (31%)||3,32 (1,00 to 11,14)||<0,05|
|Smoking (cigarettes per day)***||0±11,25||9±20||0±5||-||<0,05|
t01-fn01* Student's T test, mean ± standard deviation; ** Fisher's exact test; *** Mann-Withney test, median ± interquartile range.
Multivariate conditional logistic regression of the controlled variables selected according to a "backward stepwise" algorithm (N = 60)
|Variables||Odds Ratio (confidence interval 95%)||p|
|Females - paired||1.06 (0.19 to 5.92)||0.95|
|Current age - paired||0.62 (0.41 to 0.96)||0.03|
|Family history of hidradenitis suppurativa||20.43 (2.38 to 175.7)||<0.01|
|Smoking (cigarettes per day)||1.14 (1.02 to 1.28)||0.02|
|Body mass index||0.75 (0.46 to 1.22)||0.24|
|Body mass index versus age||1.02 (1.00 to 1.03)||<0.05|
t02-fn01Dependent variable: To present hidradenitis suppurativa; model p <0.01, correct classification = 85%.
Keywords: Hidradenitis suppurativa, Obesity, Risk factors, Smoking.
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