Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease. Increasing evidence suggests that HS involves dysfunctional immune responses in both the adaptive and the innate immune system. The recently proposed association of HS with metabolic syndrome may further add to the inflammatory state in HS. Objective: To investigate the status of inflammation and leukocyte profile in the peripheral blood of HS patients. Materials and Methods: Using a comparative cross-sectional study design, we investigated blood samples of high-sensitivity C-reactive protein (hs-CRP) and leukocyte profile in hospital-treated HS patients (HS-HOSP), self-reported population-based HS patients (HS-POP) and population controls. Results: Our study comprised 32 individuals in the HS-HOSP group, 430 in the HS-POP group, and 20,780 controls. The median hs-CRP for the HS-HOSP group was 5.1 mg/l (quartile range 2.6-8.2), 2.2 mg/l (1.0-4.3) for the HS-POP group and 1.3 mg/l (0.7-2.9) for the controls. An age-sex-adjusted analysis revealed a significantly higher hs-CRP for both HS groups compared to controls (p < 0.0001). When performing age-sex-adjusted analysis, both HS groups had significantly higher odds of leukocytosis when compared to controls with an odds ratio for the HS-HOSP group of 4.38 (95% CI = 2.18-8.80; p < 0.0001) and 1.95 (95% CI = 1.58-2.42; p < 0.0001) for the HS-POP group. The age-sex-adjusted leukocyte differential count yielded significantly higher neutrophil (p < 0.0001) and monocyte (p = 0.0014, p = 0.0004) levels in the HS groups compared with controls. Conclusion: The hs-CRP levels associated with HS appear to be intermediate (2.2-5.1 mg/l), implying systemic inflammation rather than infection. The peripheral blood leukocytosis in HS was dominated by neutrophils and monocytes.

Keywords:
Epidemiology, Hidradenitis suppurativa, White blood cells, Leukocytes, Inflammation, Infection
1.
Jemec GB: Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012;366:158-164.
2.
Vinding GR, Miller IM, Zarchi K, Ibler KS, Ellervik C, Jemec GB: The prevalence of inverse recurrent suppuration: a population-based study of possible hidradenitis suppurativa. Br J Dermatol 2014;170:884-889.
3.
Jemec GB, Heidenheim M, Nielsen NH: The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol 1996;35:191-194.
4.
Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD: Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol 2013;133:97-103.
5.
Schlapbach C, Hanni T, Yawalkar N, Hunger RE: Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol 2011;65:790-798.
6.
Hunger RE, Surovy AM, Hassan AS, Braathen LR, Yawalkar N: Toll-like receptor 2 is highly expressed in lesions of acne inversa and colocalizes with C-type lectin receptor. Br J Dermatol 2008;158:691-697.
7.
Van der Zee HH, Laman JD, Boer J, Prens EP: Hidradenitis suppurativa: viewpoint on clinical phenotyping, pathogenesis and novel treatments. Exp Dermatol 2012;21:735-739.
8.
Miller I, Lynggaard CD, Lophaven S, Zachariae C, Dufour DN, Jemec GB: A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa. Br J Dermatol 2011;165:391-398.
9.
Van der Zee HH, de Ruiter L, van den Broecke DG, Dik WA, Laman JD, Prens EP: 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 2011;164:1292-1298.
10.
Giamarellos-Bourboulis EJ, Antonopoulou A, Petropoulou C, Mouktaroudi M, Spyridaki E, Baziaka F, Pelekanou A, Giamarellou H, Stavrianeas NG: Altered innate and adaptive immune responses in patients with hidradenitis suppurativa. Br J Dermatol 2007;156:51-56.
11.
Wolk K, Warszawska K, Hoeflich C, Witte E, Schneider-Burrus S, Witte K, Kunz S, Buss A, Roewert HJ, Krause M, Lukowsky A, Volk HD, Sterry W, Sabat R: Deficiency of IL-22 contributes to a chronic inflammatory disease: pathogenetic mechanisms in acne inversa. J Immunol 2011;186:1228-1239.
12.
Miller IM, Ellervik C, Vinding GR, Zarchi K, Ibler KS, Knudsen KM, Jemec GB: Association of metabolic syndrome and hidradenitis suppurativa. JAMA Dermatol 2014;150:1273-1280.
13.
Sabat R, Chanwangpong A, Schneider-Burrus S, Metternich D, Kokolakis G, Kurek A, Philipp S, Uribe D, Wolk K, Sterry W: Increased prevalence of metabolic syndrome in patients with acne inversa. PLoS One 2012;7:e31810.
14.
Gold DA, Reeder VJ, Mahan MG, Hamzavi IH: The prevalence of metabolic syndrome in patients with hidradenitis suppurativa. J Am Acad Dermatol 2014;70:699-703.
15.
Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, Shevach A, Berliner S, Herz I, Keren G, Banai S: Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 2012;225:456-460.
16.
Guet-Revillet H, Coignard-Biehler H, Jais JP, Quesne G, Frapy E, Poiree S, Le Guern AS, Le Fleche-Mateos A, Hovnanian A, Consigny PH, Lortholary O, Nassif X, Nassif A, Join-Lambert O: Bacterial pathogens associated with hidradenitis suppurativa, France. Emerg Infect Dis 2014;20:1990-1998.
17.
Jemec GB, Faber M, Gutschik E, Wendelboe P: The bacteriology of hidradenitis suppurativa. Dermatology 1996;193:203-206.
18.
Lapins J, Jarstrand C, Emtestam L: Coagulase-negative staphylococci are the most common bacteria found in cultures from the deep portions of hidradenitis suppurativa lesions, as obtained by carbon dioxide laser surgery. Br J Dermatol 1999;140:90-95.
19.
Highet AS, Warren RE, Weekes AJ: Bacteriology and antibiotic treatment of perineal suppurative hidradenitis. Arch Dermatol 1988;124:1047-1051.
20.
Jahns AC, Killasli H, Nosek D, Lundskog B, Lenngren A, Muratova Z, Emtestam L, Alexeyev OA: Microbiology of hidradenitis suppurativa (acne inversa): a histological study of 27 patients. APMIS 2014;122:804-809.
21.
O'Loughlin S, Woods R, Kirke PN, Shanahan F, Byrne A, Drury MI: Hidradenitis suppurativa. Glucose tolerance, clinical, microbiologic, and immunologic features and HLA frequencies in 27 patients. Arch Dermatol 1988;124:1043-1046.
22.
Sartorius K, Killasli H, Oprica C, Sullivan A, Lapins J: Bacteriology of hidradenitis suppurativa exacerbations and deep tissue cultures obtained during carbon dioxide laser treatment. Br J Dermatol 2012;166:879-883.
23.
Ziglam HM, Daniels I, Finch RG: Immunomodulating activity of rifampicin. J Chemother 2004;16:357-361.
24.
Bergholdt HK, Bathum L, Kvetny J, Rasmussen DB, Moldow B, Hoeg T, Jemec GB, Berner-Nielsen H, Nordestgaard BG, Ellervik C: Study design, participation and characteristics of the Danish General Suburban Population Study. Dan Med J 2013;60:A4693.
25.
Nordin G, Martensson A, Swolin B, Sandberg S, Christensen NJ, Thorsteinsson V, Franzson L, Kairisto V, Savolainen ER: A multicentre study of reference intervals for haemoglobin, basic blood cell counts and erythrocyte indices in the adult population of the Nordic countries. Scand J Clin Lab Invest 2004;64:385-398.
26.
Shiels MS, Katki HA, Freedman ND, Purdue MP, Wentzensen N, Trabert B, Kitahara CM, Furr M, Li Y, Kemp TJ, Goedert JJ, Chang CM, Engels EA, Caporaso NE, Pinto LA, Hildesheim A, Chaturvedi AK: Cigarette smoking and variations in systemic immune and inflammation markers. J Natl Cancer Inst 2014;106:dju294.
27.
Hessam S, Sand M, Gambichler T, Bechara FG: Correlation of inflammatory serum markers with disease severity in patients with hidradenitis suppurativa (HS). J Am Acad Dermatol 2015;73:998-1005.
28.
Actor J: Elseviers' Integrated Review of Immunology and Microbiology, ed 2. Amsterdam, Elsevier, 2012.
29.
Miller IM, Ellervik C, Vinding GR, Zarchi K, Ibler KS, Knudsen KM, Jemec GB: Association of metabolic syndrome and hidradenitis suppurativa. JAMA Dermatol 2014;150:1273-1280.
30.
Van der Zee HH, de Ruiter L, Boer J, van den Broecke DG, den Hollander JC, Laman JD, Prens EP: Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin and early and chronic hidradenitis suppurativa lesions. Br J Dermatol 2012;166:98-106.
31.
Park JH, Kim JG, Cha SH, Park SD: Eosinophilic foreign body granuloma after multiple self-administered bee stings. Br J Dermatol 1998;139:1102-1105.
32.
Borriello F, Granata F, Marone G: Basophils and skin disorders. J Invest Dermatol 2014;134:1202-1210.
33.
Smith CH, Kepley C, Schwartz LB, Lee TH: Mast cell number and phenotype in chronic idiopathic urticaria. J Allergy Clin Immunol 1995;96:360-364.
34.
Boer J, Weltevreden EF: Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions. Br J Dermatol 1996;135:721-725.
35.
Kanni T, Tzanetakou V, Savva A, Kersten B, Pistiki A, van de Veerdonk FL, Netea MG, van der Meer JW, Giamarellos-Bourboulis EJ: Compartmentalized cytokine responses in hidradenitis suppurativa. PLoS One 2015;10:e0130522.
36.
Buyukkaya E, Karakas MF, Karakas E, Akcay AB, Tanboga IH, Kurt M, Sen N: Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 2014;20:159-163.
37.
Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB; Intermountain Heart Collaborative Study Group: Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-1643.
38.
Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F: Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27-31.
39.
Chen J, Deng Q, Pan Y, He B, Ying H, Sun H, Liu X, Wang S: Prognostic value of neutrophil-to-lymphocyte ratio in breast cancer. FEBS Open Bio 2015;5:502-507.
40.
Gunaldi M, Goksu S, Erdem D, Gunduz S, Okuturlar Y, Tiken E, Kahraman S, Inan YO, Genc TB, Yildirim M: Prognostic impact of platelet/lymphocyte and neutrophil/lymphocyte ratios in patients with gastric cancer: a multicenter study. Int J Clin Exp Med 2015;8:5937-5942.
41.
Yurtdas M, Yaylali YT, Kaya Y, Ozdemir M, Ozkan I, Aladag N: Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography 2014;31:1095-1104.
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