Hidradenitis suppurativa, commonly abbreviated as HS and also known as a painful, chronic skin illness called acne inversa or Verneuil’s disease, is a chronic, debilitating inflammatory disease of the follicular epithelium that results in skin abscesses and scars.
Although the precise etiology of hidradenitis suppurativa is unknown, it typically affects the groin, lower abdomen, breasts, and armpits and occurs around hair follicles where sweat glands are located.
The illness affects more women than men for unexplained reasons. It is estimated to afflict roughly 1 in 100 people.

Causes of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a complex condition where the exact causes remain somewhat elusive, but several factors have been identified that contribute to its development. The primary issue arises near hair follicles with sweat glands, typically around the groin, buttocks, breasts, and armpits ⁹.

The condition is believed to start with the blockage of hair follicles, which can be influenced by various factors, including genetics, hormones, and environmental elements. Notably, about one-third of individuals with HS have a family history of the condition, suggesting a strong genetic component ⁸⁹. Research indicates that certain genes involved in the γ-secretase complex may play a significant role, although a specific gene has not been conclusively identified ¹⁰.

Environmental factors also contribute significantly to HS. Mechanical irritation, such as friction from clothing, has been shown to exacerbate the condition. This mechanical stress can lead to keratinocyte differentiation and proliferation, which in turn contributes to the thickening of the epidermis and retention of hair follicle debris ¹⁰. Additionally, chemical irritants and alterations in the skin’s normal flora may also play a role in the development of HS ¹⁰.

Lifestyle factors are prominently associated with HS. Smoking and obesity are both strongly linked to the condition. Studies have shown that a significant percentage of individuals with HS are smokers, and this habit can alter the function of sweat glands and neutrophilic granulocytes, which may trigger or worsen the condition ^10,11. Similarly, obesity not only increases the risk of HS but also appears to influence the age of onset. The interaction between body mass index and age suggests that obesity may be a more significant risk factor in older individuals ¹¹.

It is important to note that HS is not caused by poor hygiene or infections and cannot be spread from one person to another ^7,12. This clarification is crucial in dispelling common misconceptions about the disease and reducing the stigma associated with its symptoms.

In summary, the causes of hidradenitis suppurativa are multifaceted, involving genetic predispositions, environmental factors, and lifestyle choices. Understanding these can help manage the condition more effectively and potentially develop targeted treatments.

Symptoms of Hidradenitis Suppurativa

Individuals with hidradenitis suppurativa (HS) typically experience a range of symptoms that can significantly impact their quality of life. The initial symptom is often a painful spot that resembles a deep pimple, acne cyst, or boil, commonly appearing in areas such as the armpits, groin, buttocks, or inner thigh ^17,14. These spots can develop into larger breakouts that clear temporarily, only to recur in the same or nearby areas ^17,14.

As the condition progresses, the affected skin may exhibit multiple lumps that resemble acne or boils. These lumps can grow and merge, forming abscesses filled with fluid that become increasingly painful ^17,14. The discomfort might begin before visible lumps appear, with affected areas feeling swollen and sensitive, and the skin may burn, itch, or sweat excessively ^17,14.

One of the more distressing aspects of HS is when these abscesses burst open, releasing blood and pus. This discharge has a foul odor and can stain clothing, often leading to embarrassment and social withdrawal ¹⁷. Over time, repeated cycles of healing and reopening of these wounds may lead to the formation of sinus tracts—abnormal channels beneath the skin—and permanent scarring ^17,14.

In advanced stages of HS, small black bumps that look like blackheads may appear, often in pairs, adding to the skin’s irregular appearance ¹⁷. Some individuals experience the constant presence of HS wounds, while others may have periods where only scars are visible ¹⁷.

In addition to skin symptoms, HS can also affect other aspects of health. For instance, it is associated with an increased risk of developing certain types of arthritis, leading to symptoms like joint pain and morning stiffness ¹⁷. The chronic nature of HS, coupled with the challenges in treatment and recurrent symptoms, can also lead to significant psychological distress. Individuals may suffer from anxiety, embarrassment, anger, self-consciousness, or depression due to the ongoing and persistent symptoms ¹⁸.

Management of HS symptoms often requires a comprehensive approach, including medical treatment to reduce skin lesions and prevent disease progression, lifestyle adjustments such as maintaining a healthy weight and quitting smoking, and possibly psychological counseling to address the emotional effects of the disease ¹⁶.

Conventional Treatment Options

Medications

Topical therapies such as clindamycin effectively treat superficial and localized hidradenitis suppurativa lesions (HS). Resorcinol, azelaic acid, and topical retinoids help minimize the appearance of new nodules and improve dyschromic scarring ¹⁹. Systemic medical therapy is essential for controlling nodules, abscesses, and inflammation. Commonly used antibiotics include tetracycline and its derivatives or, alternatively, cotrimoxazole, which are recommended for 16 weeks. If control is achieved, these may be withdrawn, although topical treatments like resorcinol or azelaic acid may be continued ¹⁹²⁰.

Second-line antibiotic therapy often involves clindamycin, either alone or combined with rifampin or ofloxacin, for up to 10 weeks to manage more persistent symptoms ¹⁹. For severe cases, biologic agents like adalimumab and infliximab may be employed. These agents target and dampen parts of the immune system, specifically tumor necrosis factor, to improve symptoms within weeks ²⁰.

Steroid injections such as triamcinolone acetonide can reduce swelling and inflammation when injected directly into the sores ²⁰. Hormonal therapies, including estrogen-containing oral contraceptives and spironolactone, are sometimes used to manage mild cases and reduce the need for antibiotics ²⁰. In cases where other medications are ineffective, retinoids may be prescribed, although their use is restricted during pregnancy, breastfeeding, or if pregnancy is planned ²⁰.

Surgical Procedures

Surgical interventions play a critical role in managing hidradenitis suppurativa, especially when medical treatments fail to control the disease effectively. Procedures range from minor surgeries like incision and drainage for acute relief from tender abscesses ²³ to more complex surgeries such as wide excision, where diseased tissue is extensively removed to prevent recurrence ²³²⁵. Deroofing, a procedure that involves removing the skin covering abscesses or sinus tracts, is often employed for recurrent lesions ²³.

Laser therapies, including carbon dioxide lasers and long-pulsed Nd: YAG, are used to treat HS by reducing hair or vaporizing affected tissues, which helps reduce lesions’ recurrence ²³. For extensive or severe cases, surgical removal of all affected skin followed by skin grafting might be necessary ²³. This approach is considered when other treatments have not provided relief, and it involves significant recovery time and careful wound management ²³.

Each surgical technique is chosen based on the extent, severity, and specific characteristics of the HS lesions, and often, a combination of medical and surgical treatments is necessary to manage the disease effectively ^23,27.

Natural Treatments for Hidradenitis Suppurativa

While conventional treatments for Hidradenitis Suppurativa (HS) focus on medications and surgeries, many individuals explore natural remedies to manage their symptoms. These natural treatments often provide relief and can be used in conjunction with traditional medical approaches.

Dietary Changes

Diet plays a significant role in managing HS symptoms. Adjusting one’s diet to include anti-inflammatory foods can help reduce flare-ups. The Mediterranean diet, rich in vegetables, fruits, and fish, is particularly beneficial due to its anti-inflammatory properties ^29,30,31,32. Avoiding dairy and high-glycemic foods has also shown considerable improvement in symptoms ³⁵. Some people with HS have found relief by eliminating specific foods that trigger their symptoms, such as sugar, yeast, and gluten ^29,35. Incorporating supplements like zinc and vitamin D can further support skin health and reduce inflammation ^29,35.

Mediterranean Diet for Hidradenitis Suppurativa

Exploring the intersection between diet and chronic health conditions brings to light innovative approaches to management and treatment. Among such conditions, Hidradenitis Suppurativa (HS), a chronic skin condition manifesting severe symptoms, has shown responsiveness to dietary adjustments, notably the Mediterranean diet. This condition, characterized by the development of painful lumps under the skin, has prompted extensive research into its causes, hidradenitis suppurativa (HS) symptoms, and effective treatment modalities. Understanding the role of diet not only highlights the importance of nutrition in managing chronic conditions but also offers new hope for those living with hidradenitis suppurativa, underscoring the potential of the Mediterranean diet as a supportive treatment strategy.

The article will delve into the causes of hidradenitis suppurativa and describe its symptoms, setting a foundation for understanding conventional and natural treatment options. From discussing the effectiveness of hidradenitis suppurativa homeopathic remedies and acupuncture for hidradenitis suppurativa to exploring the role of diet in disease management, the text aims to provide a comprehensive overview. By focusing on how a Mediterranean diet can influence the course of the condition, the discussion spans the spectrum from the scientific underpinnings to practical advice for individuals aiming to alleviate their symptoms through dietary changes. Through this exploration, the article intends to offer valuable insights and guide those living with hidradenitis suppurativa toward potentially life-changing dietary adjustments.

Managing Hidradenitis Suppurativa Through Diet

Foods to Include

In managing Hidradenitis Suppurativa (HS) through diet, incorporating anti-inflammatory foods is crucial. The Mediterranean diet, characterized by a high intake of fruits, vegetables, legumes, cereals, bread, fish, and extra virgin olive oil, has shown benefits in reducing HS flare-ups due to its anti-inflammatory properties ⁴³⁴⁴⁴⁵. Specific foods recommended include:

Omega-3 fatty acids, found in salmon, sardines, walnuts, flaxseed and flaxseed oil, avocados, pumpkin seeds, and chia seeds, are beneficial for HS and overall heart and brain health ⁴⁰.
Fiber-rich foods such as fresh and frozen fruits, vegetables, lentils, beans, brown rice, barley, oats, bran, couscous, and quinoa help maintain a healthy gut, which is crucial for reducing inflammation ⁴⁰⁴¹.
Low-fat dairy products like yogurt containing probiotics can reduce inflammation and benefit gut health. Choosing plain, nonfat versions is advisable to avoid added sugars ⁴¹.

Foods to Avoid

Certain foods can trigger or worsen the symptoms of HS by increasing inflammation or causing hormonal imbalances. It is recommended to avoid or limit these foods:

High-fat and processed red meats like hot dogs, sausages, and bacon are known to cause inflammation due to their high saturated fat content ⁴².
Dairy products, especially those high in fat, such as whole milk, cheese, and butter, can increase certain hormone levels that may exacerbate HS symptoms. A dairy-free diet has been shown to reduce HS flare-ups ^42,45.
Sugary foods and refined carbohydrates like desserts, white bread, and pasta lead to spikes in blood glucose and insulin levels, which can trigger HS symptoms. These foods are also nutrient-poor and may contribute to weight gain, a known risk factor for HS ^41,42.
Brewer’s yeast found in products like beer, bread, and fermented foods may trigger flare-ups, especially in individuals sensitive to gluten ^40,42.
Nightshades such as tomatoes, eggplants, potatoes, and peppers might be problematic for some individuals, although conclusive research is lacking. Eliminating these from the diet could be considered to assess if symptoms improve ⁴⁰.

Individuals with HS can manage their symptoms more effectively by carefully selecting and avoiding certain foods. Consulting healthcare professionals or dietitians to tailor dietary choices that best suit individual health needs and conditions is essential.

Homeopathy

Although more research is needed, some individuals with HS report benefiting from homeopathic treatments. Ingredients like Arsenic Album, Belladonna, and Silicea have been used to manage skin conditions similar to HS, with some cases showing significant improvement ³⁶. However, it is crucial to consult with a professional homeopath to ensure these remedies’ correct application and dosage.

Homeopathy provides an incredibly efficient treatment for those who suffer from hidradenitis suppurativa. These medications also effectively treat the recurring skin lesions associated with this complaint. They aid in lump healing, pain relief, and pus discharge removal. Because these medications are made from naturally occurring materials, they are extremely safe to take and have no negative side effects.

1. Silicea: Preeminent Herbal Treatment for Cysts, Lumps, Nodules, and Boils

A top-listed medication for these situations is silicea. It works wonders for boils, tumors, nodules, and subcutaneous cysts. In the event of boils, pus discharge—which can range from minimal to severe—is suggested. Additionally, a thin, watery discharge or a brownish discharge is indicative of it. Where this medication is necessary, the discharges are quite unpleasant.

2. Hepar Sulfur: For Excruciating Boils

This is a really helpful medication for uncomfortable boils. Using this medication may cause throbbing or pounding pain. At night, the agony usually gets worse. Over the boils, there is a lot of edema, heat, and inflammation. The highly irritating pus discharge from boils is tinged with blood when necessary. A person in need of it could also be prone to acne. Pus frequently fills these.

3. Myristica: To Hasten Boils’ Recovery

Myristica sebifera is the plant used to make this medication. This plant is a member of the Myristicaceae family. It is a really helpful medication for boils. In these situations, it speeds up the development of pus, which helps promote a speedy recovery. In these situations, prompt use of this medication frequently avoids the need for surgery.

4. Belladonna: When Heat and Swelling Are Present During the First Stage of Boils

The plants used to make this medication are frequently called deadly nightshades. This plant is a member of the Solanaceae family. This medication is recommended in the early stages of hot and swollen boils. The impacted area of the skin is touch-sensitive as well. Boils that repeat annually, especially in the spring, are another unusual sign that this medication should be used.

5. Calcarea Sulphuric Acid: For Boils Showing Yellow Pus Outflow

It’s an additional useful medication for boils. Yellow pus discharge is present in conditions that require it. This medication can be used for both acute and long-term conditions. Treating the recurring boil propensity is beneficial.

6. Sulfur: The Reaction of One Boil to Another Boil

When a boil heals in one spot and is followed by another boil at a different location, this drug is clearly advised. The boil occasionally releases blood-stained pus. It has the potential to be offensive and yellow. The boil hurts a lot and has a lot of inflammation at the base. In addition to the aforementioned uses, it is a useful medication for treating cases in which boils appear on diverse body parts.

7. Rhus Tox: When Blood-Stained Pus Is Released

This medication should be used if the boil is releasing blood-stained drainage. It hurts to touch and is swollen. Most pain has a stinging quality to it.

8. Merc Solubilis: When Yellow and Green Pus Are Discharged

Consider using this medication if yellow-green pus is discharged from the lumps. There is stinging and searing discomfort associated with this. The development of boils in women throughout their menstrual cycle is another particular sign that this medication should be used.

9. Phytolacca: For Tough, Intense Nodes or Lump

Poke root, also known as Phytolacca decandra, is the plant used to make this medication. It is a member of the Phytolaccaceae family. This medication works wonders for treating painful, hard nodes or tumors under the skin. Aside from this, it also relieves searing discomfort associated with boils. Most often, these pains worsen at night when they are necessary. There may be watery, unpleasant discharges. It is recognized to expedite the development of pus and hasten the healing process.

10. Cysts and lumps/nodules: Conium

This medication is extremely useful for treating cysts, lumps, or nodules under the skin. The nodules or lumps, are tough. This medication dissolves cysts, masses, and nodules gradually and effectively.

Acupuncture

People with HS are also exploring acupuncture as an alternative treatment. This traditional Chinese medicine technique aims to rebalance the body’s energy pathways, thereby reducing inflammation and promoting healing ³⁴. While the scientific evidence supporting acupuncture’s effectiveness in HS treatment is still emerging, many find it a valuable addition to their management strategy, particularly for pain relief and reducing inflammation ³⁴.

While potentially beneficial, these natural treatments should always be cautiously approached and, ideally, under healthcare professionals’ guidance. Each individual’s response to these treatments can vary, making personalized consultation and adjustment crucial.

Conclusion

This article has illuminated a beacon of hope for those grappling with this challenging condition by examining the intricate relationship between the Mediterranean diet and Hidradenitis Suppurativa (HS). By delving into the causes, symptoms, conventional treatments, natural remedies, and dietary strategies, we’ve underscored the significance of a holistic approach to managing HS. The Mediterranean diet, emphasizing anti-inflammatory foods, emerges as a potentially transformative element in the broader management plan for individuals battling HS. It complements medical treatments and paves the way for a lifestyle that fosters overall well-being and symptom relief.

As we wrap up our exploration, the journey toward understanding and managing Hidradenitis suppurativa does not conclude here. This discussion serves as a foundation that invites further investigation and experimentation with diet as a pivotal part of HS management. The collaboration between patients and healthcare providers is crucial in tailoring a treatment plan that includes dietary adjustments, leveraging the insights presented here. The main message is empowerment and hope, encouraging those suffering from HS to look into the Mediterranean diet as a helpful ally in their quest for better health and quality of life.

FAQs

What are common dietary triggers for hidradenitis suppurativa?

Certain foods may exacerbate the symptoms of hidradenitis suppurativa in some individuals. Common triggers include dairy products, foods high in sugar, and brewer’s yeast. Maintaining a food diary to identify and monitor any specific foods that might be triggering your symptoms can be beneficial. Additionally, avoiding nightshades might also provide relief.

What primarily causes hidradenitis suppurativa?

Hidradenitis suppurativa typically begins with the blockage of hair follicles, which then rupture and become inflamed. This condition is not a result of infection or poor hygiene. Instead, environmental factors and genetics play a significant role in its development, with smoking and obesity being the main contributors.

Is there a link between vitamin deficiencies and hidradenitis suppurativa?

Research suggests a possible inverse relationship between vitamin D levels and hidradenitis suppurativa (HS) severity. A study in Jordan indicated that individuals with HS were likelier to have lower vitamin D levels than those without the condition, suggesting that vitamin D deficiency might be more common among HS patients.

Should eggs be avoided if you have hidradenitis suppurativa?

Eggs might need to be excluded from the diet of those suffering from hidradenitis suppurativa, especially if reintroducing them appears to trigger flare-ups. The Autoimmune Protocol (AIP) diet, an extension of the paleo diet, recommends eliminating eggs, nuts, seeds, nightshades, certain spices, and sweeteners to potentially reduce symptoms.

Natural remedies, Acupuncture, and homeopathy for hidradenitis suppurativa

Living with hidradenitis suppurativa can be very annoying and significantly affect your self-esteem.

Hidradenitis suppurativa can be a massive hindrance if you like attending social functions. You must seek treatment immediately to prevent permanent scarring and emotional distress. Alternative and natural remedies for acne can relieve you without adverse effects. If you need to schedule an appointment for evaluation and treatment, contact our clinic and meet Dr. Tsan.

References