CoExistence of HS and CD

A clinical association between HS and CD has been described in some cases reports [31-33] and in one case series [34]. Gower-Rousseau et al. reported the occurrence of HS in two first-degree relatives of patients with CD [35]. This finding suggests a common genetic susceptibility for the two diseases. In the study by Church et al. [34], CD lesions were found in 24 out of 61 patients with HS. In our series of 2926 patients with CD, 18 (0.6%) have such an association. This figure should be considered as minimal, as a systematic search for HS was not made. Of note, the proportion of active smokers was 78% in our patients with both diseases. Clinical characteristics of patients with HS and CD in the two latter studies are given in Table 7.1. CD patients with HS differ from other CD patients by a higher frequency of colonic and perianal involvement, an increased need for immuno-suppressants, and, more importantly, a very unusual need for proctectomy and definitive ileos-tomy. Finally, the evolution of the two diseases is not parallel, with possible exacerbations of HS while the intestinal disease is burning out.

From a practical point of view, the occurrence of digestive symptoms or unexplained biological abnormalities (anemia, hypoferri-tinemia, elevated C-reactive protein) in one patient with HS should alert the physician and

Table 7.1. Characteristics of Crohn's disease (CD) in two series of CD associated with hidradenitis suppurativa (HS)

Cleveland Clinic

St. Antoine




Median age at diagnosis of CD (years)



CD location (small bowel/colon/both)



Perianal CD

24 (100%)

16 (88%)

Excisional surgery for CD

21 (88%)

9 (50%)


17 (71%)

8 (44%)


Not indicated

13 (72%)

lead to colonoscopy, as the presence of gastrointestinal endoscopic lesions and granulomas on biopsy establishes the diagnosis of CD. Conversely, there is a need for a systematic search for acne, folliculitis, and HS skin lesions in CD patients, particularly when a steroid treatment is planned.

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