Evaluation of Serum Zonulin Levels and Intestinal Permeability in Hidradenitis Suppurativa Patients

Background Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease. Zonulin is a signaling protein secreted by enterocytes that regulates the function of tight junction complexes and intestinal permeability. The levels of zonulin increase in the blood with the disruption of the intestinal barrier and it is used as a biomarker indicating intestinal permeability. This study aims to determine the role of intestinal permeability in the pathogenesis of HS by measuring serum zonulin levels. Methods The study included 32 patients diagnosed with HS who applied to our clinic along with 32 age and gender matched controls. Serum zonulin levels were measured using the Enzyme‐Linked Immunosorbent Assay (ELISA) method. Disease severity was assessed according to Hurley staging, the Physician's Global Assessment (HS‐PGA), and the International Hidradenitis Suppurativa Severity Score System (IHS4). Results The average serum zonulin level in HS patients was 473.53 ± 690.5 ng/mL, while in the control group it was 182.04 ± 75.11 ng/mL. Compared to the controls, serum zonulin levels were significantly higher in HS patients ( p = 0.019). Notably, this elevation persisted when comparing non‐obese HS patients to controls ( p = 0.014). However, no significant differences were found between serum zonulin levels and other parameters. Conclusions Our findings suggest that increased intestinal permeability is a feature of HS pathogenesis. The persistence of elevated zonulin in non‐obese patients indicates that barrier dysfunction may occur independently of metabolic factors. While not a marker for clinical disease severity, zonulin levels may reflect an underlying susceptibility to systemic inflammation in HS.