Low and high body mass index in hidradenitis suppurativa patients—different subtypes?

Abstract

Patients with a low and high BMI could represent two clinically different subtypes. We suggest a non-linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.

Proceeding report of the third symposium on Hidradenitis Suppurativa advances (SHSA) 2018

“…HS consists of many phenotypic presentations including the following: classic vs atypical, inflammatory vs occlusive follicular, early vs late onset and indolent vs fulminant . Further studies of the genetic background of the disease, clinical presentations, pathophysiology and associated co‐morbidities guide the understanding of the natural history of the disease.…”

Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

“…41 A cross sectional study, compared 205 HS patients with a high (above 35) body mass index (BMI) with 246 HS patients with a low BMI (below 25). 42 Those with a high BMI significantly suffered more severe disease (Hurley, PGA, number of areas affected and patient reported severity) and patients with low BMI significantly reported greater severity when they increased their BMI. 42 The authors concluded patients with a low and high BMI could represent two clinically different subtypes of HS suggesting a non-linear relationship between BMI and impact of HS.…”

“…42 The authors concluded patients with a low and high BMI could represent two clinically different subtypes of HS suggesting a non-linear relationship between BMI and impact of HS. 42 The role of androgens and sexual hormones remains controversial, 34 but many facts support a possible relation: -the typical onset in a narrow age spectrum after puberty; -rare postmenopausal onset 34 ; -usual improvement during pregnancy and post-partum flare-up 34 ; -reports of association with irregular menses, hirsutism and higher concentration of total testosterone, 43 although not constant 28,44 ; -reports of significant remission after antiandrogen therapy, although most of HS patients have normal androgen profiles 45,46 ; -HS in children under 12 is more likely associated with hormonal imbalance, namely adrenal hyperplasia, premature adrenarche, obesity, and metabolic syndrome. 47 In fact, a diagnosis of HS in children may be a marker of precocious puberty.…”

“…54 Friction may promote follicular occlusion and rupture of dilated follicles in genetically susceptible patients. 42 One study with histopathology and case reports found increased fragility of the dermoepidermal junction in HS patients, which suggests that friction may contribute to HS development. 54 …”

The Magnitude of mTORC1 Signalling May Predict the Response to Isotretinoin Treatment in Patients with Hidradenitis Suppurativa

“…On this subject matter, note that in HS mTOR gene expression statistically correlates with the severity of the disease and, like in acne vulgaris [23], with the body mass index (BMI) [13]. Recently, it has been suggested that patients with a low and high BMI could represent 2 clinically different subtypes, since eruption patterns and risk factors may change depending on the BMI value [24]. Consequently, isotretinoin might exert major anti-inflammatory effects in patients with a higher BMI.…”