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Serum Zinc Levels in Hidradenitis Suppurativa: A Case–Control Study

Abstract

Background

Serum zinc levels in patients with hidradenitis suppurativa (HS) have not been previously studied.

Objective

The aim was to investigate the association between HS and serum zinc levels.

Methods

A multicenter, prospective clinical and analytical case–control study was designed to assess the possible association between HS and serum zinc levels. Consecutive patients with moderate or severe HS (Hurley II or III exclusively) were enrolled. A control population was recruited from primary care clinics. Fasting blood samples were extracted from each patient and serum zinc levels determined. Candidate predictors for low serum zinc levels were determined using logistic regression models.

Results

In total, 122 patients with HS and 122 control subjects were studied. Of the 122 HS patients, 79 (64.8%) were Hurley II and 43 (35.2%) were Hurley III. Low serum zinc levels (≤ 83.3 µg/dL) were more prevalent in HS (adjusted odds ratio [ORa] 6.7, P < 0.001). After logistic regression analysis, low serum zinc levels were associated with Hurley III (ORa 4.4, P < 0.001), Dermatology Life Quality Index ≥ 9 (ORa 3.1, P = 0.005), number of affected sites ≥ 3 (ORa 2.4, P = 0.042), genital location (ORa 2.9, P = 0.009), and perineal location (ORa 2.5, P = 0.025).

Conclusion

Low serum zinc levels are more prevalent in HS than in a healthy population, an indicator that may also be associated with disease severity.

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References

  1. Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: an update. J Am Acad Dermatol. 2015;73(5 Suppl 1):S8–11.

    Article  PubMed  CAS  Google Scholar 

  2. Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: an update on connecting the tracts. F1000Research. 2017;6:1272.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Revuz J, Canoui-Poitrine F, Wolkenstein P, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008;59(4):596–601.

    Article  PubMed  Google Scholar 

  4. Jemec GB, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol. 2015;73(5 Suppl 1):S4–7. https://doi.org/10.1016/j.jaad.2015.07.052.

    Article  PubMed  Google Scholar 

  5. Naldi L. Epidemiology. In: Jemec G, Revuz J, Leyden J, editors. Hidradenitis suppurativa. 1st ed. Heidelberg: Springer; 2006. p. 58–64.

    Chapter  Google Scholar 

  6. Tzellos T, Zouboulis CC, Gulliver W, Cohen AD, Wolkenstein P, Jemec GB. Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies. Br J Dermatol. 2015;173(5):1142–55. https://doi.org/10.1111/bjd.14024.

    Article  PubMed  CAS  Google Scholar 

  7. Gold DA, Reeder VJ, Mahan MG, Hamzavi IH. The prevalence of metabolic syndrome in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2014;70(4):699–703. https://doi.org/10.1016/j.jaad.2013.11.014.

    Article  PubMed  Google Scholar 

  8. Pascual JC, González I, Corona D, et al. Assessment of subclinical atherosclerosis in hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2017;31(7):1229–38. https://doi.org/10.1111/jdv.14076.

    Article  PubMed  CAS  Google Scholar 

  9. González-López MA, Hernández JL, Lacalle M, et al. Increased prevalence of subclinical atherosclerosis in patients with hidradenitis suppurativa (HS). J Am Acad Dermatol. 2016;75(2):329–35. https://doi.org/10.1016/j.jaad.2016.03.025.

    Article  PubMed  Google Scholar 

  10. Shavit E, Dreiher J, Freud T, Halevy S, Vinker S, Cohen AD. Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2015;29(2):371–6. https://doi.org/10.1111/jdv.12567.

    Article  PubMed  CAS  Google Scholar 

  11. Thorlacius L, Cohen AD, Gislason GH, Jemec GB, Egeberg A. Increased suicide risk in patients with hidradenitis suppurativa. J Invest Dermatol. 2018;138(1):52–7. https://doi.org/10.1016/j.jid.2017.09.008.

    Article  PubMed  CAS  Google Scholar 

  12. Kelly G, Prens EP. Inflammatory mechanisms in hidradenitis suppurativa. Dermatol Clin. 2016;34(1):51–8. https://doi.org/10.1016/j.det.2015.08.004.

    Article  PubMed  CAS  Google Scholar 

  13. Zouboulis CC, Desai N, Emtesmat L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619–44. https://doi.org/10.1111/jdv.12966.

    Article  PubMed  CAS  Google Scholar 

  14. Riis PT, Ring HC, Kjaersgaard Andersen R, Jemec GB. Self-reported minor infections in patients with hidradenitis suppurativa and healthy controls. Clin Exp Dermatol. 2018;43(2):144–8. https://doi.org/10.1111/ced.13278.

    Article  PubMed  CAS  Google Scholar 

  15. Kelly G, Sweeney CM, Tobin AM, Kirby B. Hidradenitis suppurativa: the role of immune dysregulation. Int J Dermatol. 2014;53(10):1186–96. https://doi.org/10.1111/ijd.12550.

    Article  PubMed  Google Scholar 

  16. Dréno B, Khammari A, Brocard A, et al. Hidradenitis suppurativa: the role of deficient cutaneous innate immunity. Arch Dermatol. 2012;148(2):182–6. https://doi.org/10.1001/archdermatol.2011.315.

    Article  PubMed  CAS  Google Scholar 

  17. Ramos-Levi AM, Sánchez-Pernaute A, Rubio-Herrera MA. Dermatitis and optic neuropathy due to zinc deficiency after malabsortive bariatric surgery. Nutr Hosp. 2013;28(4):1345–7. https://doi.org/10.3305/nh.2013.28.4.6606.

    PubMed  Article  Google Scholar 

  18. Brocard A, Knol AC, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology. 2007;214(4):325–7.

    Article  PubMed  CAS  Google Scholar 

  19. Brocard A, Dréno B. Innate immunity: a crucial target for zinc in the treatment of inflammatory dermatosis. J Eur Acad Dermatol Venereol. 2011;25(10):1146–52. https://doi.org/10.1111/j.1468-3083.2010.03934.x.

    Article  PubMed  CAS  Google Scholar 

  20. Bae YS, Hill ND, Bibi Y, Dreiher J, Cohen AD. Innovative uses for zinc in dermatology. Dermatol Clin. 2010;28(3):587–97. https://doi.org/10.1016/j.det.2010.03.006.

    Article  PubMed  CAS  Google Scholar 

  21. Ozuguz P, Dogruk Kacar S, Ekiz O, Takci Z, Balta I, Kalkan G. Evaluation of serum vitamins A and E and zinc levels according to the severity of acne vulgaris. Cutan Ocul Toxicol. 2014;33(2):99–102. https://doi.org/10.3109/15569527.2013.808656.

    Article  PubMed  CAS  Google Scholar 

  22. Amer M, Bahgat MR, Tosson Z, Abdel Mowla MY, Amer K. Serum zinc in acne vulgaris. Int J Dermatol. 1982;21(8):481–4.

    Article  PubMed  CAS  Google Scholar 

  23. Giacconi R, Cai L, Costarelli L, et al. Implications of impaired zinc homeostasis in diabetic cardiomyopathy and nephropathy. BioFactors. 2017;43(6):770–84. https://doi.org/10.1002/biof.1386.

    Article  PubMed  CAS  Google Scholar 

  24. Swardfager W, Herrmann N, Mazereeuw G, Goldberger K, Harimoto T, Lanctôt KL. Zinc in depression: a meta-analysis. Biol Psychiatry. 2013;74(12):872–8. https://doi.org/10.1016/j.biopsych.2013.05.008.

    Article  PubMed  CAS  Google Scholar 

  25. Gupta M, Mahajan VK, Mehta KS, Chauhan PS. Zinc therapy in dermatology: a review. Dermatol Res Pract. 2014;2014:709152. https://doi.org/10.1155/2014/709152.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hessam S, Sand M, Neier NM, Gambichler T, Scholl L, Bechara FG. Combination of oral zinc gluconate and topical triclosan: an anti-inflammatory treatment modality for initial hidradenitis suppurativa. J Dermatol Sci. 2016;84(2):197–202. https://doi.org/10.1016/j.jdermsci.2016.08.010.

    Article  PubMed  CAS  Google Scholar 

  27. Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: cofactors for progressive fatty liver disease. J Hepatol. 2018;68(2):251–67. https://doi.org/10.1016/j.jhep.2017.11.006.

    Article  PubMed  Google Scholar 

  28. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60(4):539–61. https://doi.org/10.1016/j.jaad.2008.11.911.

    Article  PubMed  Google Scholar 

  29. Wollina U, Langner D, Heinig B, Nowak A. Comorbidities, treatment, and outcome in severe anogenital inverse acne (hidradenitis suppurativa): a 15-year single center report. Int J Dermatol. 2017;56(1):109–15. https://doi.org/10.1111/ijd.13393.

    Article  PubMed  Google Scholar 

  30. Bui TL, Silva-Hirschberg C, Torres J, Armstrong AW. Hidradenitis suppurativa and diabetes mellitus: a systematic review and meta-analysis. J Am Acad Dermatol. 2018;78(2):395–402. https://doi.org/10.1016/j.jaad.2017.08.042.

    Article  PubMed  Google Scholar 

  31. Capdor J, Foster M, Petocz P, Samman S. Zinc and glycemic control: a meta-analysis of randomised placebo controlled supplementation trials in humans. J Trace Elem Med Biol. 2013;27(2):137–42. https://doi.org/10.1016/j.jtemb.2012.08.001.

    Article  PubMed  CAS  Google Scholar 

  32. Gooderham M, Papp K. The psychosocial impact of hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(5 Suppl 1):S19–22. https://doi.org/10.1016/j.jaad.2015.07.054.

    Article  PubMed  Google Scholar 

  33. Petrilli MA, Kranz TM, Kleinhaus K, et al. The emerging role for zinc in depression and psychosis. Front Pharmacol. 2017;8:414. https://doi.org/10.3389/fphar.2017.00414.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sturniolo GC, Fries W, Mazzon E, et al. Effect of zinc supplementation on intestinal permeability in experimental colitis. J Lab Clin Med. 2002;139:311–5.

    Article  PubMed  CAS  Google Scholar 

  35. Sturniolo GC, Di Leo V, Ferronato A, et al. Zinc supplementation tightens “leaky gut” in Crohn’s disease. Inflamm Bowel Dis. 2001;7:94–8.

    Article  PubMed  CAS  Google Scholar 

  36. Siva S, Rubin DT, Gulotta G. Zinc deficiency is associated with por clinical outcomes in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(1):152–7.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

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Corresponding author

Correspondence to Inés Poveda.

Ethics declarations

Informed Consent

All cases and control patients enrolled in this study gave informed consent.

Ethical Approval

The local ethics committee approved this study, which was performed in compliance with the Declaration of Helsinki (CEIC PI2016/62.1).

Funding

No sources of funding were used to conduct this study or prepare this article.

Conflict of interest

Inés Poveda, Eva Vilarrasa, Antonio Martorell, Francisco Javier García-Martínez, Juan Manuel Segura, Patricia Hispán, José Sánchez-Payá, Pedro José Álvarez, Iris González and Jose Carlos Pascual declare that they have no conflicts of interest.

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Poveda, I., Vilarrasa, E., Martorell, A. et al. Serum Zinc Levels in Hidradenitis Suppurativa: A Case–Control Study. Am J Clin Dermatol 19, 771–777 (2018). https://doi.org/10.1007/s40257-018-0374-5

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  • DOI: https://doi.org/10.1007/s40257-018-0374-5