Patients with hidradenitis suppurativa (HS) have higher prevalence of various concomitant disorders such as obesity, diabetes, metabolic syndrome and cardiovascular disease, compared to the general population.1 Recently, metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD),2 was added to the list.3 However, previous studies have focused on the presence of harmless liver steatosis rather on the presence of advanced fibrosis, which poses a greater clinical concern due to its high morbidity and mortality.4 In addition, previous studies lack data regarding important confounders such as alcohol consumption and severity of HS.