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The Connection Between Hidradenitis Suppurativa and Liver Diseases

Medically reviewed by Raj Chovatiya, MD, PhD, MSCI
Posted on April 5, 2023

Hidradenitis suppurativa (HS) can take many forms, ranging from small bumps to scars, abscesses, and boils that typically form in areas where skin rubs together. Also known as acne inversa, this painful skin disease is sometimes accompanied by comorbidities (coexisting health conditions). For example, liver disease is a comorbidity of HS, and some members of myHSteam wonder about the connection between these two conditions.

According to a 2022 systematic review of eight studies, people with HS were more likely to also have several liver diseases, including nonalcoholic fatty liver disease (NAFLD), alcohol-related liver disease, and hepatitis B. HS may trigger or worsen other liver conditions as well.

Liver disease is dangerous and can lead to liver cancer and liver failure. Fortunately, there are ways to prevent liver disease. This article will guide you through the connection between HS and liver disease.

Liver Functions and Diseases

Your liver is located in your right upper abdomen, just below the rib cage. It’s the largest solid organ in the body — about the size of a football. A healthy liver filters all your blood to remove toxins, such as alcohol and drugs. It also produces bile, a fluid that digests fats.

Many liver conditions produce only subtle symptoms, if any. However, the following symptoms might indicate liver dysfunction:

  • Jaundice (yellowish-looking skin or eyes)
  • Itchiness
  • Stomach pain and swelling
  • Nausea or vomiting
  • Poor appetite
  • Dark urine
  • Light-colored stool
  • Fatigue

Make sure to speak with a doctor if you experience symptoms such as these, especially if they persist.

How Can Liver Issues Affect Your Skin?

It can be hard to tell if new skin symptoms are related to your HS or indicate another condition. However, the main skin symptom of liver disease — jaundice — has distinctive features, depending on a person’s natural skin tone. A yellowish appearance may be more apparent on lighter skin but more noticeable in the whites of the eyes of someone with darker skin.

Itchy skin is another symptom that may point to liver disease. Although HS can cause itchiness, it’s usually limited to areas with the HS rash, such as the groin, armpits, or thighs. Liver disease, on the other hand, can make your skin itch all over.

Liver Diseases Associated With Hidradenitis Suppurativa

Three types of liver diseases — nonalcoholic fatty liver disease, alcohol-related liver disease, and hepatitis B — are often linked with HS.

Non-Alcoholic Fatty Liver Disease

NAFLD occurs when your liver has excess fat buildup that’s not caused by heavy alcohol use. One of the most common causes of liver disease in the United States, NAFLD affects as many as 24 percent of U.S. adults, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

NAFLD is more common among people with HS. In a 2020 study of 245 people, those with HS were almost three times more likely to also have NAFLD than those without HS. Other research studies support these findings.

NAFLD often doesn’t cause symptoms. However, you may notice persistent fatigue or pain in the right side of your abdomen — fat buildup can make the liver larger and lead to discomfort.

Alcohol-Related Liver Disease

Alcohol-related liver disease develops from heavy alcohol use. One of its most common forms, alcohol-related fatty liver disease, also leads to fat buildup in the liver. The alcohol-related form isn’t as common as NAFLD, but findings of the 2022 review, published in the journal JAAD International, showed that people with HS had an almost 30 percent increased risk of developing alcohol-related liver disease compared to those without HS.

Alcohol-related liver disease rarely causes symptoms, but you may experience fatigue and discomfort in the right side of your abdomen.

Hepatitis B

Hepatitis B is a viral liver infection. For most people, this disease is short term, but some develop chronic (long-term) hepatitis B. There’s no cure, but a vaccine prevents this condition from developing.

According to a 2022 review of studies, published in the journal Frontiers in Immunology, people with HS had a 48 percent increased risk of having hepatitis B compared to those without HS.

Hepatitis B may cause jaundice, abdominal pain, nausea, vomiting, and other typical symptoms of liver conditions.

The Link Between Hidradenitis Suppurativa and Liver Diseases

Scientists don’t yet know what causes liver problems in people with HS, but the consensus is that it involves inflammation.

People with HS often have chronic systemic inflammation. This means that the immune system is always active, even when there are no invaders in the body for it to attack. If you have HS, you might have increased levels of molecules called adipokines. These molecules can stimulate inflammation, trigger the accumulation of fat, and lead to scarring in your liver.

Risk Factors for Hidradenitis Suppurativa and Liver Disease

Certain health conditions can also increase your risks of both HS and liver disease. One example is metabolic syndrome. This refers to a cluster of issues such as hypertension (high blood pressure), high blood sugar, and abnormal lipid levels. It can cause diabetes, cardiovascular (heart) disease, and liver problems. Metabolic syndrome is a dangerous condition on the rise in the United States, so it’s important to be aware of this risk if you have HS.

In addition, some risk factors for liver disease, such as smoking and obesity, are also common HS triggers.

Liver Disease and Hidradenitis Suppurativa Medications

Long-term use of certain HS treatments — for example, antibiotics and corticosteroids — can cause liver damage. Be sure to talk with your dermatology provider about the risks of your medications.

Living With Hidradenitis Suppurativa and Liver Disease

Research on whether HS and liver disease can worsen one another’s symptoms is scarce, but some studies suggest that people with liver disease have more severe forms of HS. This may happen because fat accumulation in the liver can increase the level of adipokines, leading to even more inflammation.

Be sure to ask your doctor or dermatologist if your individual situation puts you at an increased risk of worsening HS.

Lowering Your Risk of Liver Disease

Fortunately, there are ways to prevent liver disease if you have HS. Taking steps like these can help keep your liver healthy:

  • Limit alcohol consumption.
  • Maintain a healthy weight.
  • Follow a regular exercise plan.
  • Eat plenty of fruits, vegetables, whole grains, and healthy fats.
  • Quit smoking.
  • Get vaccinated against hepatitis B.

Your doctor will likely monitor the health of your liver with blood tests called liver function tests. Make sure to schedule regular appointments, and tell your doctor about any new or worrisome symptoms that may be related to HS or liver disease.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 32,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Are you living with hidradenitis suppurativa? Has your doctor talked to you about the risk of liver disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Association of Hidradenitis Suppurativa and Liver Disease: A Systematic Review and Meta-Analysis — JAAD International
  2. How Many People Have Liver Disease? — American Liver Foundation
  3. The Liver and Its Functions — Columbia Center for Liver Disease and Transplantation
  4. The Liver — Centers for Disease Control and Prevention
  5. Liver Disease — Mayo Clinic
  6. Jaundice — NHS
  7. Hidradenitis Suppurativa: Signs and Symptoms — American Academy of Dermatology Association
  8. Definition & Facts of NAFLD & NASH — National Institutes of Health
  9. Hidradenitis Suppurativa Is Associated With Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study — Acta Dermato-Venereologica
  10. Risk of Liver Dysfunction and Non-Alcoholic Fatty Liver Diseases in People With Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis of Real-World Evidences — Frontiers in Immunology
  11. Alcoholic Liver Disease — Johns Hopkins Medicine
  12. Hepatitis B — Mayo Clinic
  13. Hidradenitis Suppurativa and the Metabolic Syndrome — Clinics in Dermatology
  14. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988-2012 — Preventing Chronice Disease
  15. Drug-Induced Liver Injury Due to Antibiotics — Scandinavian Journal of Gastroenterology
  16. Corticosteroids — LiverTox: Clinical and Research Information on Drug-Induced Liver Injury
  17. Liver Enzyme Levels Are Associated With Markers of Systemic Inflammation, Disease Severity, and Metabolic Syndrome in Patients With Hidradenitis Suppurativa — Health Science Reports
    Posted on April 5, 2023
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    Raj Chovatiya, MD, PhD, MSCI is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Learn more about him here.
    Olga Askinazi, Ph.D. is a biomedical scientist, clinical educator, and health writer. Learn more about her here.

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