Hidradenitis Suppurativa and Diabetes: Understanding the Connection

Introduction

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin condition that significantly impacts patients' quality of life. Recent research has uncovered a strong association between HS and various metabolic disorders, particularly diabetes mellitus. This article explores the connection between these two conditions and its implications for patient care.

The Prevalence of Diabetes in HS Patients

Multiple studies have demonstrated a higher prevalence of diabetes mellitus among individuals with hidradenitis suppurativa compared to the general population. A meta-analysis by Bui et al. (2018) found that the prevalence of diabetes in HS patients was 10.6%, compared to 3.8% in those without HS. This significant difference highlights the importance of screening for diabetes in HS patients.

Shared Risk Factors and Inflammatory Pathways

HS and diabetes share several common risk factors and inflammatory pathways, which may explain their frequent co-occurrence:

• Obesity: A major risk factor for both conditions
• Insulin resistance: Often present in HS patients, even without overt diabetes
• Chronic inflammation: A hallmark of both HS and diabetes
• Metabolic syndrome: Frequently associated with HS

Phan et al. (2019) found that HS was associated with a 1.69-fold increased odds of diabetes after adjusting for confounding factors. This suggests that the relationship between HS and diabetes goes beyond shared risk factors and may involve common pathophysiological mechanisms.

Screening and Management Implications

Given the strong association between HS and diabetes, healthcare providers should consider implementing routine screening for diabetes in HS patients. Abu Rached et al. (2023) found that among HS patients with diabetes, type 2 diabetes was by far the most prevalent. They also identified specific risk factors that could help target screening efforts:

• Hurley stage III HS (5.3-fold increased risk of type 2 diabetes)
• Older age
• Higher BMI

Potential Therapeutic Implications

Understanding the connection between HS and diabetes may open new avenues for treatment. Some diabetes medications have shown promise in managing HS:

1. Metformin: Tsentemeidou et al. (2023) reviewed studies using metformin for HS treatment, finding potential efficacy with minimal side effects.
2. Liraglutide: Jennings et al. (2017) reported a case where this GLP-1 agonist improved HS control and led to weight loss.

Conclusion

The association between hidradenitis suppurativa and diabetes is well-established, with shared risk factors and inflammatory pathways likely contributing to their co-occurrence. Healthcare providers should be aware of this connection and consider routine diabetes screening for HS patients, especially those with severe disease, obesity, or advanced age. Further research into the shared pathophysiology of these conditions may lead to novel therapeutic approaches that address both HS and diabetes simultaneously.