High Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Hidradenitis Suppurativa: A Guide to Easily Assess the Clinical Risk of Comorbid Liver Disease

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with considerable comorbidity. The link between HS and metabolic dysfunction-associated steatotic liver disease (MASLD) is of particular interest owing to shared inflammatory pathways. This study applies the new MASLD nomenclature in a HS cohort. Our study aims to investigate the prevalence of MASLD in HS using transient elastography and to develop a clinical algorithm for assessing the MASLD risk. A cross-sectional study was conducted involving 94 patients with HS. Noninvasive methods were employed to diagnose MASLD. The clinical diagnosis was based on altered transient elastography-controlled attenuation parameter as surrogate for liver steatosis and the presence of cardiometabolic risk factors after excluding secondary causes of steatosis. Statistical analyses included logistic regression models to identify predictors of MASLD risk. The study found a prevalence of MASLD as high as 75% measured by high-accuracy transient elastography among patients with HS. Multivariable logistic regression analysis showed a strong within-cohort association between HS and MASLD. The newly developed clinical algorithm integrating transient elastography and the Fatty Liver Index effectively stratified MASLD risk. Our findings underscore the importance of routine MASLD screening in HS. The proposed clinical algorithm offers a straightforward approach for assessing MASLD risk in HS.