Skip to main content

Advertisement

SpringerLink
Log in

Hidradenitis suppurativa is associated with acne keloidalis nuchae: a population-based study

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

The association between acne keloidalis nuchae (AKN) and hidradenitis suppurativa (HS) is yet to be investigated. To determine the link between AKN and HS using a large computerized health maintenance database. A cross-sectional study design was used to assess the prevalence of HS in patients with AKN and in control participants matched by age, sex, and ethnicity. A total of 2677 participants with AKN and 13,190 control participants were studied. An increased prevalence of HS was observed in the AKN group compared to the control group (1.0% vs. 0.3%, respectively; OR, 3.6; 95% CI 2.2–5.8; P < 0.001), especially among those younger than 20 years (OR, 10.2; 95% CI 3.1–34.2; P < 0.001), and females (OR, 15.7; 95% CI 3.1–78.8; P < 0.001). After adjusting for confounding factors, the multivariate analysis demonstrated a persistent association of AKN with HS (adjusted OR, 3.6; 95% CI 2.1–5.9; P < 0.001). This study demonstrated a significant association between AKN and HS in an Israeli population. The threshold for diagnosis of HS among patients with AKN must be lowered in patients presenting with concerning symptoms. Further observational studies in other patient populations will help confirm this relationship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dinehart SM, Herzberg AJ, Kerns BJ, Pollack SV (1989) Acne keloidalis: a review. J Dermatol Surg Oncol. 15(6):642–647

    Article  CAS  Google Scholar 

  2. Adegbidi H, Atadokpede F, do Ango-Padonou F, Yedomon H (2005) Keloid acne of the neck: epidemiological studies over 10 years. Int J Dermatol 44(Suppl 1):49–50

    Article  Google Scholar 

  3. Papavramidou N, Karpouzis A (2017) Early reports of “sycosis”. JAMA Dermatol. 153(3):303

    Article  Google Scholar 

  4. Stelwagon HW (1907) Treatise on diseases of the skin: for the use of advanced students and practitioners. W.B. Saunders, Philadelphia

    Google Scholar 

  5. Sperling LC, Homoky C, Pratt L, Sau P (2000) Acne keloidalis is a form of primary scarring alopecia. Arch Dermatol 136(4):479–484

    Article  CAS  Google Scholar 

  6. Glenn MJ, Bennett RG, Kelly AP (1995) Acne keloidalis nuchae: treatment with excision and second-intention healing. J Am Acad Dermatol 33(2 Pt 1):243–246

    Article  CAS  Google Scholar 

  7. Halder RM (1983) Hair and scalp disorders in blacks. Cutis 32(4):378–380

    CAS  PubMed  Google Scholar 

  8. East-Innis ADC, Stylianou K, Paolino A, Ho JD (2017) Acne keloidalis nuchae: risk factors and associated disorders—a retrospective study. Int J Dermatol 56(8):828–832

    Article  Google Scholar 

  9. Garg A, Wertenteil S, Baltz R, Strunk A, Finelt N (2018) Prevalence estimates for hidradenitis suppurativa among children and adolescents in the United States: a gender- and age-adjusted population analysis. J Investig Dermatol. 138(10):2152–2156

    Article  CAS  Google Scholar 

  10. Garg A, Kirby JS, Lavian J, Lin G, Strunk A (2017) Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 153(8):760–764

    Article  Google Scholar 

  11. Slade DE, Powell BW, Mortimer PS (2003) Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg 56(5):451–461

    Article  CAS  Google Scholar 

  12. Alikhan A, Lynch PJ, Eisen DB (2009) Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 60(4):539–561 (quiz 62–63)

    Article  Google Scholar 

  13. 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 

  14. Giamarellos-Bourboulis EJ, 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

    Article  CAS  Google Scholar 

  15. 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

    Article  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  17. 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

    Article  CAS  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. Wertenteil S, Strunk A, Garg A (2019) Overall and subgroup prevalence of acne vulgaris among patients with hidradenitis suppurativa. J Am Acad Dermatol 80(5):1308–1313

    Article  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  21. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 40(5):373–383

    Article  CAS  Google Scholar 

  22. Ogunbiyi A (2016) Acne keloidalis nuchae: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 9:483–489

    Article  Google Scholar 

  23. Chicarilli ZN (1987) Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. Ann Plast Surg 18(3):230–237

    Article  CAS  Google Scholar 

  24. Vasanth V, Chandrashekar BS (2014) Follicular occlusion tetrad. Indian Dermatol Online J. 5(4):491–493

    Article  Google Scholar 

  25. Shapero J, Shapero H (2011) Acne keloidalis nuchae is scar and keloid formation secondary to mechanically induced folliculitis. J Cutan Med Surg. 15(4):238–240

    Article  Google Scholar 

  26. Lee DE, Clark AK, Shi VY (2017) Hidradenitis suppurativa: disease burden and etiology in skin of color. Dermatology 233(6):456–461

    Article  Google Scholar 

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

    Article  Google Scholar 

  28. 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

    Article  CAS  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. 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

    Article  CAS  Google Scholar 

  32. Saunte DML, Jemec GBE (2017) Hidradenitis suppurativa: advances in diagnosis and treatment. JAMA 318(20):2019–2032

    Article  Google Scholar 

  33. Ergun T (2018) Hidradenitis suppurativa and the metabolic syndrome. Clin Dermatol 36(1):41–47

    Article  Google Scholar 

  34. Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD (2015) Hidradenitis suppurativa and metabolic syndrome: a comparative cross-sectional study of 3207 patients. Br J Dermatol 173(2):464–470

    Article  CAS  Google Scholar 

Download references

Acknowledgements

IRB has exempted this study from review.

Funding

None.

Author information

Author notes

  1. Kyle T. Amber and Arnon D. Cohe contributed equally to this study.

Authors and Affiliations

  1. Lűbeck Institute of Experimental Dermatology, University of Lűbeck, RatzeburgerAllee 160, 23562, Lübeck, Germany

    Khalaf Kridin

  2. Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA

    Payal M. Patel, Virginia A. Jones & Kyle T. Amber

  3. Clalit Healthcare Services, Tel Aviv, Israel

    Arnon D. Cohen

  4. Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA

    Giovanni Damiani

  5. Young Dermatologists Italian Network, GISED, Bergamo, Italy

    Giovanni Damiani

  6. Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Giovanni Damiani

Authors
  1. Khalaf Kridin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Payal M. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Virginia A. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Damiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyle T. Amber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arnon D. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khalaf Kridin.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kridin, K., Patel, P.M., Jones, V.A. et al. Hidradenitis suppurativa is associated with acne keloidalis nuchae: a population-based study. Arch Dermatol Res 313, 333–337 (2021). https://doi.org/10.1007/s00403-020-02105-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-020-02105-x

Keywords

Search

Navigation