While patients with HS often have a family history of the disease, the much stronger HS link is obesity, according to Dr. Jemec.
“There is no convincing data that the quality of the diet plays a role, such as specific foods, but quite strong data that the quantity plays a role. Most patient have a high BMI, prevalence and diseases severity correlates with BMI and BMI reduction appears to induce remission,” Dr. Jemec says.
Smoking seems highly associated with the disease, according to Dr. Prens.
“Ninety percent [of HS patients] are active smokers or past smokers…,” Dr. Prens says.
Risk factors, comorbidities
According to Dr. Miller, the main comorbidities and risk factors in HS are:
• Autoimmune diseases, such as Crohn’s disease
• Diseases involving follicular occlusion, including acne
• Malignancies such as squamous cell carcinoma
• Psychological comorbidities, such as depression
• Metabolic syndrome, including obesity, hypertension, diabetes and dyslipidemia
“Both the metabolic syndrome and smoking constitute cardiovascular risk factors, which is something HS has in common with psoriasis,” Dr. Miller says. “Preliminary data on body composition was presented demonstrating that HS patients not only have higher body mass index, but also higher fat percentage and lower muscle percentage compared to controls. This may suggest fat maldistribution, or perhaps even an altered metabolism altogether [may be a better description than BMI].”
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For many of these comorbidities, studies suggest and HS association, rather than cause, according to Dr. Miller.
“The complexity of causality in many of these comorbidities are still to be explored. For example, we still do not know whether the association with metabolic syndrome is caused by HS or is due to confounders, such as lifestyle,” Dr. Miller says. “I also presented some cutting-edge additional preliminary results from Danish studies on HS suggesting that these patients may have a tendency of gallstones and renal hyperfiltration, which may be a sign of early renal damage.”1