Hidradenitis suppurativa and pemphigus: a cross-sectional study

Abstract

A recent study of comorbidities in hospitalized pemphigus patients in the United States has demonstrated a significant association of hidradenitis suppurativa (HS) and pemphigus, but this association has not been firmly established in other populations. A retrospective, cross-sectional study was undertaken to determine the prevalence of HS in patients with pemphigus and compare with control subjects. Regression analysis was performed to obtain ORs, and 95% CIs, to evaluate the prevalence between pemphigus patients and controls matched by age, sex, and ethnicity. Among the patients included in the study, 1985 patients had pemphigus and 9874 were control subjects. The average age of presentation of pemphigus was 72.1 ± 18.5 and the group was comprised of 59.8% females. Overall, the pemphigus group had lower rates of smoking (25.7% vs. 27.9%; P = 0.045). The prevalence of HS was greater in patients with pemphigus than in control subjects (OR 4.98; 95% CI 1.01–24.69; P < 0.001), with an even more prominent association among patients who have been prescribed “pemphigus-related treatments” (OR 6.30; 95% CI 1.27–31.22; P < 0.001). The study detected a significant association between HS and pemphigus in an Israeli population. Future prospective studies are needed to establish a temporal order of appearance and the mechanistic relationship between these entities.

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References

  1. 1.

    Kridin K, Khamaisi M, Comaneshter D, Batat E, Cohen AD (2018) Autoimmune thyroid diseases and thyroid cancer in pemphigus: a big data analysis. Front Med (Lausanne) 5:159

    Google Scholar 

  2. 2.

    Schmidt E, Kasperkiewicz M, Joly P (2019) Pemphigus. Lancet 394(10201):882–894

    CAS  PubMed  Google Scholar 

  3. 3.

    Amber KT, Valdebran M, Grando SA (2018) Non-desmoglein antibodies in patients with pemphigus vulgaris. Front Immunol 9:1190. https://doi.org/10.3389/fimmu.2018.01190

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Di Zenzo G, Amber KT, Sayar BS, Müller EJ, Borradori L, editors (2016) Immune response in pemphigus and beyond: progresses and emerging concepts. Seminars in immunopathology, Springer.

  5. 5.

    Kridin K (2018) Pemphigus group: overview, epidemiology, mortality, and comorbidities. Immunol Res 66(2):255–270

    PubMed  Google Scholar 

  6. 6.

    Hsu DY, Brieva J, Sinha AA, Langan SM, Silverberg JI (2016) Comorbidities and inpatient mortality for pemphigus in the USA. Br J Dermatol. 174(6):1290–1298

    CAS  PubMed  Google Scholar 

  7. 7.

    Heelan K, Mahar AL, Walsh S, Shear NH (2015) Pemphigus and associated comorbidities: a cross-sectional study. Clin Exp Dermatol 40(6):593–599

    CAS  PubMed  Google Scholar 

  8. 8.

    Manthiram K, Zhou Q, Aksentijevich I, Kastner DL (2017) The monogenic autoinflammatory diseases define new pathways in human innate immunity and inflammation. Nat Immunol 18(8):832–842

    CAS  PubMed  Google Scholar 

  9. 9.

    Ambiel MV, Roselino AM (2014) Prevalence of metabolic syndrome and its components in a Brazilian sample of pemphigus patients. An Bras Dermatol 89(5):752–756

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Kridin K, Zelber-Sagi S, Comaneshter D, Cohen AD (2017) Ulcerative colitis associated with pemphigus: a population-based large-scale study. Scand J Gastroenterol 52(12):1360–1364

    PubMed  Google Scholar 

  11. 11.

    Kridin K, Amber K, Khamaisi M, Comaneshter D, Batat E, Cohen AD (2018) Is there an association between dipeptidyl peptidase-4 inhibitors and autoimmune disease? A Popul Based Study Immunol Res 66(3):425–430

    CAS  Google Scholar 

  12. 12.

    Pescitelli L, Ricceri F, Prignano F (2018) Hidradenitis suppurativa and associated diseases. G Ital Dermatol Venereol 153(3 Suppl 2):8–17

    PubMed  Google Scholar 

  13. 13.

    Dauden E, Lazaro P, Aguilar MD, Blasco AJ, Suarez C, Marin I et al (2018) Recommendations for the management of comorbidity in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 32(1):129–144

    CAS  PubMed  Google Scholar 

  14. 14.

    Shlyankevich J, Chen AJ, Kim GE, Kimball AB (2014) Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis. J Am Acad Dermatol 71(6):1144–1150

    PubMed  Google Scholar 

  15. 15.

    Alikhan A, Lynch PJ, Eisen DB (2009) Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 60(4):539–561 quiz 62-3

    PubMed  Google Scholar 

  16. 16.

    Vural S, Gundogdu M, Akay BN, Boyvat A, Erdem C, Kocyigit P, et al. (2019) Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatol Ther 32(5):e13003

    PubMed  Google Scholar 

  17. 17.

    Giamarellos-Bourboulis E, Antonopoulou A, Petropoulou C, Mouktaroudi M, Spyridaki E, Baziaka F et al (2007) Altered innate and adaptive immune responses in patients with hidradenitis suppurativa. Br J Dermatol 156(1):51–56

    CAS  PubMed  Google Scholar 

  18. 18.

    Kanni T, Zenker O, Habel M, Riedemann N, Giamarellos-Bourboulis E (2018) Complement activation in hidradenitis suppurativa: a new pathway of pathogenesis? Br J Dermatol 179(2):413–419

    CAS  PubMed  Google Scholar 

  19. 19.

    Kohorst JJ, Kimball AB, Davis MD (2015) Systemic associations of hidradenitis suppurativa. J Am Acad Dermatol 73(5 Suppl 1):S27–35

    PubMed  Google Scholar 

  20. 20.

    Kridin K, Kridin M, Shalom G, Cohen AD (2019) The coexistence of pemphigus and psoriasis: a systematic review and meta-analysis. Immunol Res 67(1):134–141

    CAS  PubMed  Google Scholar 

  21. 21.

    Kridin K, Zelber-Sagi S, Comaneshter D, Cohen AD (2017) Association between pemphigus and psoriasis: a population-based large-scale study. J Am Acad Dermatol 77(6):1174–1175

    PubMed  Google Scholar 

  22. 22.

    Garg A, Papagermanos V, Midura M, Strunk A (2018) Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the USA. Br J Dermatol. 178(3):709–714

    CAS  PubMed  Google Scholar 

  23. 23.

    Rennert G, Peterburg Y (2001) Prevalence of selected chronic diseases in Israel. Isr Med Assoc J 3(6):404–408

    CAS  PubMed  Google Scholar 

  24. 24.

    Utrera-Busquets M, Romero-Maté A, Castaño Á, Alegre L, García-Donoso C, Borbujo J (2016) Severe hidradenitis suppurativa complicated by renal AA amyloidosis. Clin Exp Dermatol 41(3):287–289

    CAS  PubMed  Google Scholar 

  25. 25.

    Iannone M, Oranges T, Chiricozzi A, De Tata V, Romanelli M, Dini V (2019) Potential role of serum amyloid A in hidradenitis suppurativa. JAAD Case Rep 5(5):406

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Pearce N (2016) Analysis of matched case-control studies. BMJ 352:i969

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Margesson LJ, Danby FW (2014) Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol 28(7):1013–1027

    PubMed  Google Scholar 

  28. 28.

    Balighi K, Daneshpazhooh M, Azizpour A, Lajevardi V, Mohammadi F, Chams-Davatchi C (2016) Koebner phenomenon in pemphigus vulgaris patients. JAAD Case Rep 2(5):419–421

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Hameed A, Khan A (1996) Koebner phenomenon in pemphigus vulgaris. Br J Dermatol 135(1):152–153

    CAS  PubMed  Google Scholar 

  30. 30.

    Li S, Zhang Q, Wang P, Li J, Ni J, Wu J et al (2018) Association between HLA-DQB1 polymorphisms and pemphigus vulgaris: a meta-analysis. Immunol Invest 47(1):101–112

    CAS  PubMed  Google Scholar 

  31. 31.

    Lapins J, Olerup O, Emtestam L (2001) No human leukocyte antigen-A, -B or -DR association in Swedish patients with hidradenitis suppurativa. Acta Derm Venereol 81(1):28–30

    CAS  PubMed  Google Scholar 

  32. 32.

    Mozeika E, Pilmane M, Nurnberg BM, Jemec GB (2013) Tumour necrosis factor-alpha and matrix metalloproteinase-2 are expressed strongly in hidradenitis suppurativa. Acta Derm Venereol 93(3):301–304

    PubMed  Google Scholar 

  33. 33.

    van der Zee HH, de Ruiter L, van den Broecke DG, Dik WA, Laman JD, Prens EP (2011) Elevated levels of tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-alpha and IL-1beta. Br J Dermatol 164(6):1292–1298

    PubMed  Google Scholar 

  34. 34.

    Wolk K, Warszawska K, Hoeflich C, Witte E, Schneider-Burrus S, Witte K et al (2011) Deficiency of IL-22 contributes to a chronic inflammatory disease: pathogenetic mechanisms in acne inversa. J Immunol 186(2):1228–1239

    CAS  PubMed  Google Scholar 

  35. 35.

    De Vita V, McGonagle D (2018) Hidradenitis suppurativa as an autoinflammatory keratinization disease. J Allergy Clin Immunol 141(5):1953

    PubMed  Google Scholar 

  36. 36.

    Chen WT, Chi CC (2019) Association of hidradenitis suppurativa with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. https://doi.org/10.1001/jamadermatol.2019.0891

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Fimmel S, Zouboulis CC (2010) Comorbidities of hidradenitis suppurativa (acne inversa). Dermatoendocrinol 2(1):9–16

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Vinkel C, Thomsen SF (2017) Autoinflammatory syndromes associated with hidradenitis suppurativa and/or acne. Int J Dermatol 56(8):811–818

    CAS  PubMed  Google Scholar 

  39. 39.

    Gibson FT, Amber KT (2019) Autoimmune blistering diseases provoked during the treatment of chronic inflammatory disease with biologic agents: a systematic review. Int J Dermatol. https://doi.org/10.1111/ijd.14686

    PubMed  Article  Google Scholar 

  40. 40.

    Gange RW, Rhodes EL, Edwards CO, Powell ME (1976) Pemphigus induced by rifampicin. Br J Dermatol 95(4):445–448

    CAS  PubMed  Google Scholar 

  41. 41.

    Miyagawa S, Yamashina Y, Okuchi T, Konoike Y, Kano T, Sakamoto K (1986) Exacerbation of pemphigus by rifampicin. Br J Dermatol 114(6):729–732

    CAS  PubMed  Google Scholar 

  42. 42.

    Goldberg I, Ingher A, Brenner S (2004) Pemphigus vulgaris triggered by rifampin and emotional stress. Skinmed 3(5):294

    PubMed  Google Scholar 

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Correspondence to Kyle T. Amber.

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Conflict of interest

A.D.C has served as a consultant, advisor or speaker for AbbVie, Amgen, Boehringer Ingelheim, Dexcel pharma, Janssen, Lilly, Neopharm, Novartis, Perrigo, Pfizer and Rafa and has received research grants from Janssen, Novartis, and AbbVie unrelated to this paper. K.K., V.A.J, P.M.P, F.T.G, and K.T.A have no conflicts of interests to declare relevant to this paper.

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Kridin, K., Jones, V.A., Patel, P.M. et al. Hidradenitis suppurativa and pemphigus: a cross-sectional study. Arch Dermatol Res 312, 501–505 (2020). https://doi.org/10.1007/s00403-020-02040-x

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Keywords

  • Hidradenitis suppurativa
  • Pemphigus
  • Cross-sectional study