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Treatment – Diet

By Editorial Team · October 18, 2020

Hidradenitis suppurativa (HS) is a painful disease with many treatments but no cure. Many people with HS are interested in changing their diet in the hope of reducing their disease and stopping its progression to a more severe stage.1

HS is a chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. Sporadic flares make symptoms worse. The process leads to:2,3

  • Abscesses
  • Pus
  • Odor
  • Inflammation
  • Tunnels under the skin
  • Scars
  • Impaired mobility

Studies have found that there is a link between the health of the digestive system and the health of the skin. However, more research is needed to better understand the impact of diet changes.4,5

Popular diets include:

  • Paleo
  • Autoimmune protocol
  • Anti-inflammatory
  • Whole30
  • Elimination

Some of the diets reduce symptoms of comorbidities (2 or more diseases or conditions that occur at the same time). This suggests that these diets might also be effective against HS.6

Paleo diet and HS

The paleo diet is based on eating habits of humans’ Paleolithic (Stone Age) ancestors. As hunter-gatherers, they are believed to have had a diet that included:7

  • Meat and fish
  • Insects
  • Roots
  • Green vegetables
  • Seasonal fruit and nuts

The Paleo diet is free of:

  • Gluten
  • Dairy
  • Grains
  • Legumes
  • Nightshades, including potatoes, tomatoes, eggplant, paprika, and peppers

The diet is thought to promote gut health and prevent bacterial overgrowth. Studies show that the paleo diet reduces symptoms of some autoimmune diseases. Since HS is linked to autoimmune diseases, the paleo diet may help people with HS.4,8,9

Research shows positive effects on the HS comorbidities of obesity and metabolic syndrome. Metabolic syndrome is a group of conditions that includes large waist size, abnormal triglyceride and cholesterol levels, high blood pressure, and high blood sugar. The syndrome increases the risk of heart disease, stroke, and type 2 diabetes.7,10

Potential risks from the paleo diet include lack of vitamin D and calcium.7

Autoimmune protocol diet

The autoimmune protocol diet is similar to the paleo diet but more restrictive. This diet may help control HS flares. The autoimmune protocol diet promotes meats and vegetables. It limits:4,11

  • Gum
  • Eggs
  • Nuts and seeds
  • Coffee and alcohol
  • Oils
  • Refined sugars and artificial sweeteners

Anti-inflammatory diet

The anti-inflammatory diet limits dairy, fat, carbohydrates, and fiber. It is designed to reduce frequency and severity of inflammatory bowel disease flares. By decreasing inflammation and maintaining a balance of helpful bacteria in the gut, the diet may reduce HS symptoms.12

The diet includes:12

  • Lean meats, poultry, and fish
  • Eggs
  • Certain carbohydrates
  • Fruits and vegetables
  • Nut and legume flours
  • Limited aged cheeses
  • Yogurt and kefir
  • Miso and honey

It may include mineral and vitamin supplements to make up for missing nutrients. Prebiotics, such as bananas, oats, chicory root, and flax meal, are suggested.12

Whole30 diet

Another similar diet is the Whole30, which also eliminates processed food, sugar, alcohol, dairy, and gluten for 30 days.13

Potential risks include a lack of B vitamins, iron, and fiber.13

Elimination diets

Besides eliminating certain foods as part of more complete diets, some people stop eating just specific foods:

  • Nightshades – may increase “leaky gut,” which allows harmful substances to pass from the digestive system into the rest of the body. This may cause inflammation, which leads to HS symptoms.4
  • Dairy – contain hormones and growth factors that may contribute to obesity and HS symptoms. In a small study of people with HS on a dairy-free diet, more than 80 percent reported improvement. None reported worsening of the disease.14,15
  • Sugar and other refined carbohydrates – may cause blood sugar to rise, triggering inflammation and HS symptoms. Early research suggests that keeping blood sugar low may help prevent new lesions and avoid the growth of existing lesions.16
  • Brewer’s yeast – may trigger HS symptoms, especially in people with wheat intolerance. In a small study, eliminating beer and foods made with yeast caused HS symptoms to stabilize. Within a year, HS lesions regressed. If the person drank beer or ate food containing yeast or wheat, the lesions returned immediately.17
Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. Kurzen H, Kurzen M. Secondary prevention of hidradenitis suppurativa. Dermatol Reports. 2019 Sep 19; 11(2):8243. Epub 2019 Oct 25. doi:10.4081/dr.2019.8243.
  2. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  3. Jemec GBE. Clinical practice: Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi:10.1056/NEJMcp1014163.
  4. Silfvast-Kaiser A, Youssef R, Paek SY. Diet in hidradenitis suppurativa: a review of published and lay literature. International Journal of Dermatology. 2019. doi:10.1111/ijd.14465.
  5. Dempsey A, Butt M, Kirby JS. Prevalence and impact of dietary avoidance among individuals with hidradenitis suppurativa. Dermatology. 2020;236:289-295. https://doi.org/10.1159.000503063.
  6. Comorbidity. National Institute on Drug Abuse. Available at https://www.drugabuse.gov/drug-topics/comorbidity. Accessed 8/26/2020.
  7. Tarantino G, Citro V, Finelli C. Hype or reality: should patients with metabolic syndrome-related NAFLD be on the hunter-gatherer (paleo) diet to decrease morbidity? J Gastrointestin Liver Dis. 2015 Sept; 24(3):359-368. doi:10.15403/jgld.2014.1121.243.gta.
  8. Cordain L. An elimination diet approach for conditions like hidradentis suppurativa and autoimmune disease. 2013 Sept 30. The Paleo Diet. Available at https://thepaleodiet.com/part-i-hidradenitis-suppurativa-and-the-paleo-diet. Accessed 8/27/2020.
  9. Constantinou CA, Fragoulis GE, Nikiphorou E. Hidradenitis suppurativa: infection, autoimmunity, or both? Ther Adv Musculoskel Dis. 2019 Dec 30;11:1-14. doi:10.1177/1759720X19895488.
  10. Dictionary definition: metabolic syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Available at https://www.niddk.nih.gov/Dictionary/M/metabolic-syndrome. Accessed 7/21/2020.
  11. Chandrasekaran A, Groven S, Lewis JD, et al. An autoimmune protocol diet improves patient-reported quality of life in inflammatory bowel disease. Crohn’s & Colitis 360. 2019 Oct;1(3). Epub 2019 Aug 7. doi:10.1093/crocol/otz019.
  12. Olendzki BC, Silverstein TD, Persuitte GM, et al. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutrition Journal, 2014;13:5. Available at http://www.nutritionj.com/content/13/1/5. Accessed 8/26/2020.
  13. Pember SE, Rush SE. Motivation for gluten-free diet adherence among adults with and without a clinically diagnosed gluten-related illness. Californian Journal of Health Promotion, 2016;14(2),68-73. doi:10.32398/cjhp.v14i2.1876.
  14. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28:1013-1027. doi:10.1016/j.bpobgyn.2014.07.012.
  15. Alikhan A, Sayed C, Alavi A, 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(1):76‐90.
  16. Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S52-S54. doi:10.1016/j.jaad.2015.07.042.
  17. Cannistrà C, Finocchi V, Trivisonno A, Tambasco D. New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer’s yeast-exclusion diet. Surgery 2013 Nov;154:1126-1130. doi:10.1016/j.surg.2013.04.018.

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