General Dermatology

Hepcidin Levels Distinguish Chronic Disease Anemia From Iron Deficiency Anemia in Hidradenitis Suppurativa

Emily Pond
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HS is divided into 3 stages according to Hurley classifications3: Stage 1: Early formation of single or multiple transient abscesses without development of scarring or sinus tracts Stage 2: Recurrent disease characterized by the formation of multiple inflammatory lesions with some tunnel development and scarring Stage 3: Chronic, active disease in which large areas of skin are infected with abscesses with significant scarring and tunneling between lesions It is important to note that Hurley classifications provide static definitions of HS disease, but do not capture transitional changes as they occur.

HS is divided into 3 stages according to Hurley classifications3:

Stage 1: Early formation of single or multiple transient abscesses without development of scarring or sinus tracts
Stage 2: Recurrent disease characterized by the formation of multiple inflammatory lesions with some tunnel development and scarring
Stage 3: Chronic, active disease in which large areas of skin are infected with abscesses with significant scarring and tunneling between lesions

It is important to note that Hurley classifications provide static definitions of HS disease, but do not capture transitional changes as they occur.

Elevated hepcidin levels were consistent with anemia of chronic disease and anemia of chronic disease/iron deficiency anemia compared with iron deficiency anemia.

Hepcidin levels can be used to determine anemia type in patients with hidradenitis suppurativa (HS), study data published in the Journal of the American Academy of Dermatology indicates.

Practitioners at the Hidradenitis Suppurativa Center (HSC) at Montefiore Medical Center in New York City noted that anemia is highly prevalent in patients with HS but does not always resolve with oral iron supplementation. Investigators thus hypothesized that some patients with HS had anemia of chronic disease (ACD) rather than anemia from iron deficiency.

To clarify this association, serum samples were collected from 113 consecutive patients treated at the HSC from November 2018 to March 2019. Samples were analyzed for levels of hepcidin, the master regulator of iron homeostasis. Anemia was defined as hemoglobin (Hb) levels less than 13 g/dL in men and less than 12 g/dL in women. Based on bloodwork parameters, patients were categorized as having iron deficiency anemia (IDA), mixed ACD/IDA, ACD, or other anemia type. Area under the receiver operating characteristic curve was used to characterize the capacity of hepcidin levels to distinguish between anemia types.

The prevalence of anemia in the study cohort was high, at 43%, the study authors noted. The significant prevalence of anemia may have partially been a function of disease severity in the cohort; 77% of patients had moderate to severe HS per Physician Global Assessment score. The distribution of patients by anemia types was as follows: 4 with IDA, 26 with ACD/IDA, 7 with ACD, and 64 not anemic. All patients with IDA had mild HS severity. Compared with the IDA group, hepcidin was significantly elevated in the ACD (P <.001) and ACD/IDA (P <.01) participant groups. Hepcidin was also elevated in the ACD group compared with patients with ACD/IDA (P <.01). Hepcidin levels accurately distinguished between IDA and ACD/IDA at a cut-off value of 9.09 ng/mL. In addition, hepcidin levels above 52.5 ng/mL accurately identified patients with ACD over patients with ACD/IDA.

Per these data, elevated hepcidin levels were consistent with ACD and ACD/IDA compared with IDA.

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As study limitations, investigators noted the small study cohort and single study site. Further research is necessary to better clarify hepcidin thresholds for characterizing anemia in HS, they indicated.

“The approval of an hepcidin assay for clinical use should be useful for managing anemia in HS patients, reducing the costly workup, and avoiding unnecessary iron replacement therapy,” investigators wrote.

Disclosure: Two study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Ghias MH, Johnston AD, Babbush KM, et al. Hepcidin levels can distinguish anemia of chronic disease from iron deficiency anemia in a cross-sectional study of patients with hidradenitis suppurativa. J Am Acad Dermatol. Published online April 1, 2021. doi: 10.1016/j.jaad.2021.03.090

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