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Is there a diet for hidradenitis suppurativa?


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A healthy diet can help people manage diseases ranging from diabetes to heart disease. To find out if diet could also benefit people with hidradenitis suppurativa (HS), dermatologists have been running small studies. While we need more research to know how diet affects HS, here’s what these early studies show.

Weight loss diet: In a few small studies, weight loss was shown to lessen (and sometimes clear) HS in people who were overweight or obese. During one small study, most patients who lost 15% or more of their body weight benefitted. Nearly 50% saw their HS clear, and 20% had fewer HS lumps.1

These studies also found that weight loss works best in the early stages of HS when you have painful lumps in your skin but no tunnels beneath.2

Mediterranean diet: This diet consists of mostly fresh vegetables and fruits, whole grains, fish, beans, seafood, and extra virgin olive oil. You rarely eat red meat. You also cut out processed foods, including sugary drinks, diet soda, bacon, cold cuts, chicken nuggets, hot dogs, and the like.

When a dermatologist in Arizona surveyed her patients with HS, she discovered that patients who followed a Mediterranean diet had fewer HS flare-ups than patients who ate foods not allowed on the Mediterranean diet.3

In a small study conducted in Italy, where many people eat a Mediterranean diet, researchers also discovered this connection. In this study, 41 patients had HS and 41 did not have HS. All of the patients were asked to record what they ate for seven days.

The researchers found that the patients with HS ate fewer foods found in the Mediterranean diet than did the patients without HS.4

Plant-based diet: The human gut contains trillions of microorganisms, which help keep us healthy. Scientists have discovered the following about these microorganisms:

  • The more diverse these microorganisms, the healthier a person tends to be.

  • The people who have the most diverse microorganisms in their guts eat only plant-based foods like vegetables, fruits, whole grains, and beans.

Dermatologists wanted to know if this knowledge could help their patients with HS, so they looked at the diversity of microorganisms in patients with HS and those without HS.

If you’re wondering, doctors can figure out the diversity of microorganisms in your gut by looking at a stool (poop) sample.

In a small study, dermatologists found that patients with HS had less diverse microorganisms than did patients without HS. This suggests that the patients with HS were eating fewer vegetables, fruits, and other healthy plant-based foods than were the patients without HS.5 While more research is needed in this area, it’s possible that eating a plant-based diet could lead to fewer HS flare-ups.

Sugar-free diet: Eating sugar causes insulin levels in your body to rise. As your insulin rises, it could increase HS flare-ups.

While research studies are needed to prove that cutting down on sugar can reduce HS flare-ups, it might be helpful to eat less sugar.6

Your body stores extra sugar as fat, which leads to weight gain. Being overweight or obese can worsen HS.

Dairy-free diet: A small study found that when 47 patients with HS went dairy-free, 83% of these patients had less HS and none of these patients had worsening HS. The patients in this study who did not stop eating dairy products did not have fewer HS flare-ups.7, 8

If you decide to go dairy-free, be sure to include foods that give you calcium and vitamin D. These nutrients are essential for your good health.

Food sensitivities: If you have a food sensitivity, it might contribute to your HS flare-ups.

To test this idea, researchers have removed the following from the diets of patients with HS:

  • Alcohol

  • Brewer’s yeast

  • Gluten

In one 12-month study, 12 patients followed a brewer’s yeast-free diet. They no longer had bread or other baked goods, vinegar, soy sauce, beer, wine, or fermented cheese. At the beginning of this study, these patients also had an in-office procedure to treat their HS.

During the year in which they followed the restricted diet, they had no flare-ups of HS. The HS flare-ups began once the diet ended.9

While this is too small of a study to recommend that people with HS stop consuming foods and drinks that contain brewer’s yeast, food sensitivities may be a topic that you want to discuss with your dermatologist.

Vitamin and mineral supplements: Researchers have taken a close look at two supplements in particular:

  • Zinc

  • Vitamin D

While the studies are small, some findings suggest that zinc can reduce HS flares. In a small study of 22 patients who had mostly mild or moderate HS, taking a zinc supplement helped when medication failed. Eight patients saw their HS go away, and 14 had less HS.10, 11, 12

Before you rush to buy a zinc supplement, it’s important to know that taking zinc can cause side effects. When you get too much zinc, it can cause vomiting and diarrhea. In very high doses, it can damage your kidneys or stomach.13 If you’re interested in taking zinc to treat HS, talk with your dermatologist first.

Vitamin D is another supplement that dermatologists have been studying. If you have HS and low vitamin D in your blood, taking a vitamin D supplement might help.

Vitamin D

Dermatologists recommend getting vitamin D from foods, supplements, or both rather than from the sun. Spending time in the sun without sun protection (or using a tanning bed) can increase your risk of developing skin cancer.

Young African American woman applying sunscreen.

Twenty-two patients who had low levels of vitamin D were given a vitamin D supplement. Once their vitamin D level was within the normal range, 63% noticed a small decrease in HS.14

Like zinc, taking too much vitamin D can cause possible side effects. If you have too much vitamin D in your body, it can cause nausea, vomiting, and a feeling of weakness.15

Be sure to talk with your dermatologist or doctor before taking any vitamin or other supplement to treat HS.

Ask your dermatologist about diet

While these findings suggest that what you eat and drink can help control (or worsen) HS, there is no one diet for HS.

Because these studies were small and looked at different approaches, it’s not clear what works. Like treatment for HS, the most effective diet for you may be unique to your needs.

If you’re interested in following a certain diet or discovering what happens when you stop eating certain foods, talk with your dermatologist or primary care doctor. The type of HS you have, your overall health, and whether you have a food sensitivity all play a role in determining the best way to work diet into your treatment plan.

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References
Alikhan A, Sayed C, et al. “North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations, Part I: Diagnosis, evaluation, and the use of complementary and procedural management.” J Am Acad Dermatol. 2019;81:76-90.

Barrea L, Fabbrocini G, et al. “Role of nutrition and adherence to the Mediterranean diet in the multidisciplinary approach of hidradenitis suppurativa: Evaluation of nutritional status and its association with severity of disease.” Nutrients. 2018 Dec 28;11(1):57.

Choi F, Lehmer L, et al. “Dietary and metabolic factors in the pathogenesis of hidradenitis suppurativa: a systematic review.” Int J Dermatol. 2020 Feb;59(2):143-53.

Danby FW. “Diet in the prevention of hidradenitis suppurativa.” J Am Acad Dermatol. 2015; 73(5 Suppl 1):S52-4.

Kurzen H, Kurzen M. “Secondary prevention of hidradenitis suppurativa.” Dermatol Reports. 2019 Oct 25;11(2):8243.

Lyons AB, Shabeeb N, et al. “Emerging medical treatments for hidradenitis suppurativa.” J Am Acad Dermatol 2020;83(2):554-62.

Narla S, Price KN, et al. “Proceeding report of the fourth Symposium on Hidradenitis Suppurativa Advances (SHSA) 2019.” J Am Acad Dermatol. (2020), doi:https://doi.org/10.1016/. [epub ahead of print].

Sivanand A, Gulliver WP, et al. “Weight loss and dietary interventions for hidradenitis suppurativa: A systematic review.” J Cutan Med Surg. Jan/Feb 2020;24(1):64-72.

Thompson KG, Kim N. “Dietary supplements in dermatology: A review of the evidence for zinc, biotin, vitamin D, nicotinamide, and Polypodium.” J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.04.123. [Article in press].

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