Deranged Iron Status Evidenced by Iron Deficiency Characterizes Patients with Hidradenitis Suppurativa

Abstract

Background: Proinflammatory activation and autoimmune processes underlie the pathophysiology of hidradenitis suppurativa (HS). Iron deficiency (ID) is frequently present in inflammation-mediated chronic diseases, irrespective of anemia. Objectives: We aimed to characterize iron status in patients with HS. Methods: Serum concentrations of ferritin, transferrin saturation (Tsat), soluble transferrin receptor and hepcidin were assessed as the biomarkers of iron status in 74 patients with HS and 44 healthy subjects. ID was defined as ferritin <100 µg/L or ferritin 100–299 µg/L with Tsat <20% (following the definition used in the other studies in chronic disease). Results: Compared with controls, patients with HS demonstrated a deranged iron status as evidenced by decreased levels of ferritin (91 ± 87 vs. 157 ± 99 µg/L), Tsat (21.5 ± 10.8 vs. 42.2 ± 11.7%) and hepcidin (31.3 ± 25.9 vs. 44.2 ± 22.0 ng/mL) (all p < 0.05 vs. controls). There was also a trend toward higher values of soluble transferrin receptor (1.23 ± 0.35 vs. 1.12 ± 0.19 mg/L) (p = 0.09 vs. controls). Disease severity (assessed with the Hidradenitis Suppurativa Severity Index and the 3-degree Hurley scale) did not differentiate iron status biomarkers. ID was present in 75% of HS patients, and its prevalence was not related with disease severity (Hurley I/II/III – 82 vs. 73 vs. 67%). In HS, none of the iron status biomarkers correlated with the levels of interleukin-6 (a marker of proinflammatory activation). Conclusions: The majority of HS patients demonstrate derangements in iron status typical of ID. These abnormalities are neither related to proinflammatory activation nor associated with disease severity. Whether it may have a therapeutic impact needs to be further studied.

Cumulative Inflammation and HbA1c Levels Correlate with Increased Intima-Media Thickness in Patients with Severe Hidradenitis Suppurativa

“…On the other hand, as it has been recently described, HS, as a chronic inflammatory disease, is related to iron deficiency [61]. Since iron deficiency has been associated with higher cardiovascular risk [62], future studies addressing the relationship between iron deficiency and cardiovascular risk in HS would be of great interest.…”

Target molecules for future hidradenitis suppurativa treatment

“…IL‐23), which directly influence IL‐17 levels 36‐38 and subsequent cellular activity. There is a plethora of theoretical basis for assessing the role of JAK‐STAT blockade in reducing inflammation in HS given associations with not only Th17 cells, but also neutrophil chemotaxis, 38,39 B cell migration and activation, 39 as well as prominent comorbidities such as iron deficiency anaemia 40 given the role of JAKs in haematopoesis.…”

Anemia in patients with hidradenitis suppurativa

“…[28][29] Some studies, especially those attempting to analyze comorbidities of HS, have demonstrated a positive association between anemia and HS. [30][31][32][33][34] However, the association between the two conditions is not yet conclusive, as other studies have indicated lack of an association. 35 Furthermore, studies to date are of varying methodological designs, with study samples bearing different demographics.…”

“…35 Furthermore, studies to date are of varying methodological designs, with study samples bearing different demographics. [30][31][32][33][34][35] Therefore, in order to better understand the association between HS and anemia, we systematically reviewed the existing literature and performed a metanalysis, paying special attention given to the methodological quality of relevant studies. We also sought to characterize the subtypes of anemia associated with HS.…”