Hidradenitis Suppurativa Closely Linked with Childhood Weight

Weight throughout childhood was predictive of developing hidradenitis suppurativa in adulthood, according to a Danish study.

Infants who were born with low birth weight -- 4.4 to 6.1 lbs (2.00- 2.75 kg) -- saw a 36% increased risk for developing this painful, chronic inflammatory skin disease later in life (HR 1.36, 95% CI 1.10-1.68), reported Astrid-Helene Ravn Jørgensen, MD, of Bispebjerg Hospital in Copenhagen, and colleagues.

On the other side of this U-shaped association, heavier babies weighing from 9.4 to 12.1 lbs (4.26-5.50 kg) had a 39% increased risk for developing hidradenitis suppurativa compared with normal weight babies weighing from 7.2 to 8.3 lbs (3.26-3.75 kg) (HR 1.39, 95% CI 1.01-1.93), according to the study online in JAMA Dermatology.

Weight in adolescence also held a significant association for developing the skin condition in adulthood: At age 7, there was a 32% increased risk for hidradenitis suppurativa per every body mass index (BMI) z-score increase (HR 1.32, 95% CI 1.24-1.40). By age 13, there was a 50% higher risk per increasing BMI z-score (HR 1.50, 95% CI 1.40-1.61).

The development of overweight throughout childhood was also tied to adulthood hidradenitis suppurativa, the researchers reported. Kids who were of normal weight at age 7 but considered to be overweight by age 13 saw more than a two-fold higher risk for hidradenitis suppurativa (HR 2.11, 95% CI 1.63-2.74). However, kids who were persistently overweight at age 7 through 13 had the highest level of increased risk (HR 2.61, 95% CI 2.02-3.38).

One promising finding, though, was that those who were overweight at age 7 but lost the weight, returning to normal weight by age 13, mitigated any increased risk for the skin condition (HR 1.05, 95% CI 0.67-1.67), the researchers found.

At any age, childhood height was not a risk factor for developing hidradenitis suppurativa as an adult, the team found.

"Given the prevalence of insulin resistance among patients with [hidradenitis suppurativa], these findings suggest that there may be some common underlying mechanistic pathways," Jørgensen's group explained.

The researchers said that although the exact cause of hidradenitis suppurativa is not well understood, known risk factors include a family history of the condition, smoking, adult obesity, and being female. In addition, adults with obesity tend to have more severe cases of the condition, as well as lower long-term remission rates.

The cohort analysis included data from the Copenhagen School Health Records Register on nearly 350,000 schoolchildren born from 1930 to 1996. School doctors and nurses collected data on childhood weight and height from ages 7 to 13, whereas birth weight was reported by parents or guardians. Cases of hidradenitis suppurativa were identified through hospital discharge diagnoses, with a median age at diagnosis of 39 years.

"Early body weight monitoring provides the opportunity to implement preventive measures aimed at reducing BMI and thus [hidradenitis suppurativa] development," the researchers said. "For treating clinicians and other health care workers, this monitoring may be particularly relevant in children with a hereditary predisposition to [hidradenitis suppurativa]."

Jørgensen and co-authors noted that they expect that the prevalence of the skin condition will continue to rise as childhood obesity rates increase worldwide.

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