Recep DURSUN, Gözde ULUTAŞ DEMİRBAŞ, Abdullah DEMİRBAŞ, Mustafa ATASOY, Ömer Faruk ELMAS, Hediye EKER, Torello LOTTİ, Ümit TÜRSEN

The relationship between hidradenitis suppurativa and irritable bowel syndrome: a cross-sectional study

Background/aim: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder in which one experiences abdominal pain, tension, cramping, bloating, and changes in the form and frequency of defecation, without an underlying organic disease. Many skin diseases have been reported to be more common in people with functional bowel disease. To our knowledge, however, no previous study investigated the potential relationship between hidradenitis suppurativa (HS) and IBS. In this study, we aimed to examine the potential association between IBS and HS. Materials and methods: Patients with HS and healthy subjects were enrolled in this cross-sectional study. All participants were assessed for the presence of IBS. ROME IV criteria were used to identify IBS cases. Hurley staging, modified Sartorius score, and physician’s global assessment score were applied to define clinical severity and staging of HS. Results: According to the Rome IV diagnostic criteria, 54 (67.50%) of 80 HS patients and 23 (28.75%) of 80 control group were diagnosed with IBS. The frequency of IBS was statistically significantly higher in the patient group than in the control group (P < 0.001). No statistically significant difference was found between the two groups in terms of abnormal stool frequency and family history of IBS (P = 0.28, P = 0.862, respectively). Abnormal stool form, mucus in stool, abdominal distension, feeling of incomplete evacuation were statistically significantly higher in HS patients compared to the controls (P = 0.01, P = 0.02, P < 0.001, P = 0.001, respectively). Conclusion: Our study revealed that there might be a potential link between HS and IBS.

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1. Marzano AV, Chiricozzi A, Giovanardi G, Argenziano G, Bettoli V et al. Creation of a severity index for hidradenitis suppurativa that includes a validated quality-of-life measure: the HIDRAscore. Journal of the European Academy of Dermatology and Venereology 2020 ;34(8):1815-1821. doi: 10.1111/jdv.16328
2. Napolitano M, Megna M, Timoshchuk EA, Patruno C, Balato N et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clinical, Cosmetic and Investigational Dermatology 2017;10:105–115. doi: 10.2147/CCID.S111019
3. Alatas ET, Biteker M, Alatas OD. Epicardial fat thickness is increased and associated with disease severity in hidradenitis suppurativa. Archives of Dermatological Research 2020; 312 (7):467-472. doi: 10.1007/s00403-019-02032-6
4. Frew JW. Hidradenitis suppurativa is an autoinflammatory keratinization disease: a review of the clinical, histologic, and molecular evidence. Journal of The American Academy of Dermatology International 2020;1(1): 62-72.doi: 10.1016/j. jdin.2020.05.005
5. List EK, Pascual JC, Zarchi K, Nürnberg BM, Jemec GBE. Mast cells in hidradenitis suppurativa: a clinicopathological study. Archives of Dermatological Research 2019;311(4):331- 335. doi: 10.1007/s00403-019-01910-3
6. Maarouf M, Platto JF, Shi VY. The role of nutrition in inflammatory pilosebaceous disorders: implication of the skin-gut axis. Australasian Journal of Dermatology 2019; 60 (2):90-98. doi: 10.1111/ajd.12909
7. Balato A, Caiazzo G, Annunziata MC, Marasca C, Scala E et al. Anti-TNF-α therapy modulates mTORC1 signalling in hidradenitis suppurativa. Journal of the European Academy of Dermatology and Venereology 2019; 33(1):43-45. doi: 10.1111/jdv.15160
8. Nagai S, Kurebayashi Y, Koyasu S. Role of PI3K/Akt and mTOR complexes in Th17 cell differentiation. Annals of the New York Academy of Sciences 2013;1280(1):30-34. doi: 10.1111/nyas.12059
9. Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. The New England Journal of Medicine 2017; 376(26):2566-2578. doi: 10.1056/NEJMra1607547
10. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clinical Gastroenterology and Hepatology 2012; 10 (7):712-721. doi: 10.1016/j.cgh.2012.02.029
11. Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. The Lancet Gastroenterology and Hepatology 2016;1(2):133-146. doi: 10.1016/S2468- 1253(16)30023-1
12. Salem I, Ramser A, Isham N, Ghannoum MA. The gut microbiome as a major regulator of the gut-skin axis. Frontiers in Microbiology 2018; 9: 1459. doi: 10.3389/fmicb.2018.01459
13. Wang FY, Chi CC. Rosacea, germs, and bowels: a review on gastrointestinal comorbidities and gut-skin axis of rosacea. Advances in Therapy 2021; 38(3):1415-1424. doi: 10.1007/ s12325-021-01624-x
14. Szántó M, Dózsa A, Antal D, Szabó K, Kemény L et al. Targeting the gut-skin axis-probiotics as new tools for skin disorder management? Experimental Dermatology 2019; 28(11):1210-1218. doi: 10.1111/exd.14016
15. Lam SY, Radjabzadeh D, Eppinga H, Nossent YRA, van der Zee HH et al. A microbiome study to explore the gut-skin axis in hidradenitis suppurativa. Journal of Dermatological Science 2021; 101(3):218-220. doi: 10.1016/j.jdermsci.2020.12.008
16. Ratanasirintrawoot S, Israsena N. Stem cells in the intestine: possible roles in pathogenesis of irritable bowel syndrome. Journal of Neurogastroenterology and Motility 2016;22(3):367-382. doi: 10.5056/jnm16023
17. Choghakhori R, Abbasnezhad A, Hasanvand A, Amani R. Inflammatory cytokines and oxidative stress biomarkers in irritable bowel syndrome: association with digestive symptoms and quality of life. Cytokine 2017; 93(2017):34-43. doi: 10.1016/j.cyto.2017.05.005
18. Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. Journal of the European Academy of Dermatology and Venereology 2015; 29(4):619-644. doi: 10.1111/jdv.12966
19. Wang SC, Wang SC, Alavi A, Alhusayen R, Bashash M et al. Hidradenitis suppurativa: a frequently missed diagnosis, part 2: treatment options. Advances in Skin & Wound Care 2015;28(8):372-380. doi: 10.1097/01. ASW.0000466712.21948.8a
20. Sartorius K, Emtestam L, Jemec GB, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. British Journal of Dermatology 2009;161(4):831-839. doi: 10.1111/j.1365-2133.2009.09198.x
21. Kimball AB, Kerdel F, Adams D, Mrowietz U, Gelfand JM et al. Adalimumab for the treatment of moderate to severe hidradenitis suppurativa: a parallel randomized trial. Annals of Internal Medicine 2012;157(12):846-855. doi: 10.7326/0003- 4819-157-12-201212180-00004
22. Mínguez Pérez M, Benages Martínez A. The Bristol scale - a useful system to assess stool form? Revista Española de Enfermedades Digestivas 2009; 101(5):305-311.
23. Can G, Yılmaz B. İrritabl barsak sendromunun tanı ve tedavisinde yaklaşımlar. Güncel Gastroenteroloji Dergisi 2015; 19(3):171–181 (in Turkish).
24. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Alimentary Pharmacology & Therapeutics 2003;17(5):643-650. doi: 10.1046/j.1365-2036.2003.01456.x
25. Chen WT, Chi CC. Association of hidradenitis suppurativa with inflammatory bowel disease: a systematic review and meta-analysis. Journal of the American Medical Association Dermatology 2019;155(9):1022-1027. doi: 10.1001/ jamadermatol.2019.0891
26. Koloski N, Jones M, Walker MM, Veysey M, Zala A et al. Population based study: atopy and autoimmune diseases are associated with functional dyspepsia and irritable bowel syndrome, independent of psychological distress. Alimentary Pharmacology & Therapeutics 2019;49 (5):546-555. doi: 10.1111/apt.15120
27. Ekiz Ö, Balta I, Özuğuz P, Şen BB, Rifaioğlu EN et al. Irritable bowel syndrome in patients with chronic pruritus of undetermined origin. Journal of the European Academy of Dermatology and Venereology 2014;28(8):1034-1039. doi: 10.1111/jdv.12251
28. Shalom G, Magen E, Babaev M, Horev A, Freud T et al. Chronic urticaria and irritable bowel syndrome: a cross-sectional study of 11 271 patients. British Journal of Dermatology 2018;178 (3):204-206. doi: 10.1111/bjd.15997
29. Demirbaş A, Elmas ÖF. The relationship between acne vulgaris and irritable bowel syndrome: a preliminary study. Journal of Cosmetic Dermatology 2021; 20 (1): 316-320. doi: 10.1111/ jocd.13481
30. Kaya İslamoğlu ZG, Unal M, Küçük A. Atopic dermatitis in adults and irritable bowel syndrome: a cross-sectional study. Indian Journal of Dermatology 2019; 64 (5):355-359. doi: 10.4103/ijd.IJD_490_18
31. Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JP. Rosacea and gastrointestinal disorders: a population-based cohort study. British Journal of Dermatology 2017;176(1):100- 106. doi: 10.1111/bjd.14930