A rare, chronic skin condition may be putting patients at risk for developing Crohn’s disease.
A rare, chronic skin condition called hidradenitis suppurativa may be putting patients at risk for developing Crohn’s disease. According to recent evidence, hidradenitis suppurativa shares clinical and pathogenic features with Crohn’s disease, suggesting that the two chronic conditions may be linked. Clinically, they both involve the formation of sterile abscesses in the perineal and inguinal regions and respond well to tumor necrosis factor alpha inhibitors. Pathogenically, an atypical immune response is considered a major factor in the onset of both of these chronic conditions.
The lumps that are not to be ignored
Hidradenitis suppurativa affects 1% of the population. It is characterized by small and painful lumps that form underneath the skin. These lumps typically develop in areas where skin touches skin: inner thigh area, armpits, groin area, beneath the breasts and between the buttocks.
The skin condition develops when the hair follicles get inflamed and blocked, although it remains unknown as to why these blockages happen to begin with. It is believed, however, that some factors may play a role in its onset, including hormones, genetics, excess weight, smoking, or an irregular immune response.
Generally, hidradenitis suppurativa starts after puberty. It can persist for several years and progressively worsen over time, triggering severe effects on day to day living and emotional well-being. Some of the most common symptoms brought about by this long-term skin condition include:
- Tender, red bumps – These bumps can open and leak pus, producing a strong odor. Itchiness and burning sensation can be associated with them.
- Painful lumps – These lumps are hard and form underneath the skin. They can last for years. They may also become inflamed.
- Blackheads – These small pitted areas of skin containing blackheads may appear in pairs on the skin.
- Tunnels – Over time, more lumps may form and eventually lead to the formation of tunnels underneath the skin. Tunnels heal very slowly and they can leak pus.
Stress, excess weight, heat, and hormonal changes are all factors that are associated with a worsening of symptoms. However, in women, the skin condition’s severity may lessen after menopause.
Supporting an association
In order to determine both the occurrence and connection between hidradenitis suppurativa and Crohn’s disease, researchers from the department of dermatology at the Donald and Barbara Zucker School of Medicine conducted a cross-sectional analysis of data from the electronic heath records of 51,340 patients with hidradenitis suppurativa in the United States. 35,000 of these patients were women, of whom over half were between the ages of 18 and 44.
The researchers found a greater occurrence of Crohn’s disease among the patients with hidradenitis suppurativa, as opposed to individuals without the skin condition. They also found that Crohn’s disease was more prevalent among the patients who were aged 45-64, Caucasian, not obese, and smokers. Additional research revealed that the patients with hidradenitis suppurativa had an over 3.29 times higher risk for developing Crohn’s disease, as opposed to a 3.05 times higher risk among individuals without the skin condition.
Crohn’s disease was associated with hidradenitis suppurativa throughout all of the patient subgroups, especially among the patients who were male, the patients who were aged 45-64, the patients who were not obese, as well as the patients who were non-smokers. This lead the research team to derive to the conclusion that patients with hidradenitis suppurativa who develop gastrointestinal symptoms similar to that of Crohn’s disease should seek medical attention. Early intervention can lead to optimized treatment and prevent the onset of unwanted complications.
The study was published in the journal JAMA Dermatology.
Sharing close mechanisms
Another study, conducted by researchers at the University of Copenhagen, revealed that hidradenitis suppurativa sufferers may be at increased risk of developing an inflammatory bowel condition, such as Crohn’s disease. “In HS patients presenting with gastrointestinal complaints, timely referral for gastroenterological evaluation of IBD [inflammatory bowel disease] may be appropriate” wrote Alexander Egeberg, lead author of the study, and fellow researchers.
The study involved the participation of 7,732 people diagnosed with hidradenitis suppurativa, as well as a 4,354,137 control group from the general population. The researchers found that the occurrence of Crohn’s disease was twofold higher in the patients with hidradenitis suppurativa, as opposed to that of the general population. Similarly, the occurrence of ulcerative colitis was around 1.8-fold higher in the patients with hidradenitis suppurativa, as opposed to that of the general population. In addition, the occurrence of “unspecified” inflammatory bowel disease was 3.4-fold higher.
Dr. Egeberg and his fellow researchers found that hidradenitis suppurativa and inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) shared pathogenic similarities, including: the worsening effect of smoking on both conditions, the formation of scars, the formation of sinus tract, the co-involvement of genes such as SULT1B1 and SULT1E1, and the involvement of T-helper 17 cells, interleukin-23, and tumor necrosis factor. “Finally, an increased prevalence of spondyloarthropathy has been reported in patients with IBD as well as in those with HS, raising the hypothesis that genetic, epigenetic, and/or environmental factors cooperate to lead to dysregulated inflammatory pathways across these immune-mediated diseases” they wrote.
The researchers did acknowledge that the population sample of the study was mainly of North European descent, and that the results may not be applicable to patients of other ethnic backgrounds. The study was published in the Journal of Investigative Dermatology.
Coping with HS: A rollercoaster of ups and downs
Unfortunately, there is no cure for hidradenitis suppurativa. However, diagnosing the skin condition at an early stage and treating it properly can help to manage the symptoms, as well as to avoid the onset of Crohn’s disease. Several treatment options are available - including topical and oral drugs, hormones, pain medication, surgery, etc. – although it is necessary to talk with a doctor about the risks and benefits associated with each one.
Medical management helps promote wound healing and keeps other lumps from appearing. It also helps prevent complications, such as scarring or depression. Self-care is also an important accompaniment to any medical treatment for hidradenitis suppurativa. The following lifestyle and home remedies may be helpful in alleviating discomfort and speeding up the healing process:
- Maintaining a healthy diet
- Maintaining a healthy weight and staying active
- Managing pain with a warm washcloth or another sort of compress
- Following a daily skin-care routine
- Avoiding tight clothing and irritating products
- Avoiding irritating the skin by squeezing the pimples and sores
- Avoiding shaving the affected areas
- Avoiding all tobacco products
Among the biggest obstacles of living with hidradenitis suppurativa is dealing with pain and embarrassment. In spite of maintaining good self-care, painful sores may affect sleep patterns, sex life or even mobility. Finding support among family and friends is important. It may also be comforting to talk with a mental health professional or to join a support group.
Although the aforementioned studies are not the first to show a possible association between hidradenitis suppurative and Crohn’s disease, the research reinforces the link between both chronic conditions. Going forward, further research is necessary for the potential therapeutic implications of these results.