Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder marked by painful nodules, abscesses, sinus tracts, and fibrotic scarring. While HS is primarily recognized for its cutaneous manifestations, increasing evidence suggests that systemic inflammation and metabolic dysregulation may contribute to disease pathology. The mechanisms linking HS to broader metabolic consequences, however, remain incompletely understood. This study aimed to (i) characterize systemic metabolic alterations in patients with HS, (ii) evaluate their association with disease severity within a moderate to severe disease spectrum, and (iii) identify potential metabolic pathways that may contribute to inflammation and organ dysfunction. Blood samples from 72 patients with moderate or severe HS were analysed and compared to healthy controls using NMR spectroscopy. Our results revealed a consistent pattern of metabolic alterations, including hyperglycemia, nonketotic acidosis, increased circulating branched-chain amino acids with concomitant decreases in branched-chain keto acids, and elevated levels of succinate, phenylalanine, and tyrosine.Most metabolic changes showed only modest associations with clinical severity within the studied cohort, suggesting that systemic metabolic dysregulation is a feature of HS in moderate to severe disease rather than being tightly linked to lesion burden. We conclude that these alterations reflect complex interorgan metabolic interactions, where energy metabolism and inflammation are closely interconnected, complicating the interpretation of causal relationships. This study provides a foundation for future investigations into metabolic targets for therapeutic intervention and underscores the importance of considering systemic consequences in HS management.
Vorčáková et al. (Fri,) studied this question.