Food as Medicine in Hidradenitis Suppurativa: A Review of Dietary Effects on Hidradenitis Suppurativa Pathogenesis

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition with multifactorial pathogenesis involving genetic, hormonal, immune, and microbiome-related factors. HS has variable presentations and variable responses to therapy, raising the topic of multimodal approaches to mitigate disease. Diet has become a point of interest for HS, with certain foods reported to exacerbate symptoms (e.g., dairy, bread, high-fat foods). Western dietary patterns, characterized by high intake of ultra-processed foods, dairy, sugar, and low fiber, seem to support the association of HS with obesity and metabolic syndrome. Diets, such as the Mediterranean, ketogenic, paleolithic, vegan, and elimination diets, have been suggested or trialed for HS, though there is a lack of research investigating their effects on HS symptoms. This review synthesizes current evidence on the relationship between dietary patterns and HS mechanisms to guide clinicians to make appropriate and evidence-based dietary recommendations for patients. Uncontrolled studies have suggested improvement in HS symptoms with intermittent fasting, brewer’s yeast elimination, and dairy elimination, but few high-quality studies have been conducted for HS. Due to a lack of high-quality dietary studies conducted for HS, data from many of the discussed diets are drawn from studies on patients without HS. Encouraging fruit and vegetable consumption while decreasing intake of ultra-processed foods are common features of these diets for reducing inflammation and maintaining a healthy gut microbiome. Less data are available regarding dietary effects on the skin microbiome. Micronutrient deficiencies, such as zinc and vitamin D, should also be addressed as they can contribute to disease burden and have some potential in alleviating symptoms. Finally, proper dietary guidance requires personalization toward a patient’s comorbidities, socioeconomic factors, and preferences to enhance adherence and outcomes.