Treatment - Lifestyle Modifications

Reviewed by: HU Medical Review Board | Last reviewed: July 2022 | Last updated: March 2023

Hidradenitis suppurativa (HS) is a disease that affects much more than a person’s body – it impacts a person’s entire life. Modifying important aspects of life is one way you can take back control from the disease.

HS is a painful, chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. Sporadic flares make symptoms worse. The process leads to:1,2

  • Abscesses
  • Pus
  • Odor
  • Inflammation
  • Sinus tracts (tunnels under the skin)
  • Scars
  • Impaired mobility

These are lifestyle modifications that can make a difference with HS symptoms, including:

  • Smoking cessation
  • Weight loss
  • Stress management

Smoking cessation

About 90 percent of people with HS are current or former smokers. Multiple studies have found a link between HS and smoking. Nicotine found in tobacco stimulates plugging of hair follicles, creating new HS lesions (sores).3-5

There is some evidence that smoking may make HS worse and stopping may improve HS. Tobacco smoke contains thousands of chemicals, which have the potential to increase skin inflammation and interfere with healing.1,5-7

Stopping smoking is recommended as a way to decrease HS symptoms, as well as other diseases, such as cancer and heart disease. Smoking cessation programs aimed specifically toward women are important, since nearly 3 times as many women as men have HS.3,8,9

Weight loss

More than 75 percent of people with HS are either overweight or obese. Some research shows that the higher a person’s body mass index (measure of body fat based on height and weight), the more severe their HS symptoms.3,10

Obesity may also promote HS development by increasing:5,8

  • Inflammation
  • Friction between skin and clothing or between 2 body parts
  • Sweat retention, which can irritate the skin and foster growth of microbes

Weight loss benefits people with HS. It may:11

  • Decrease HS prevalence and severity
  • Improve long-term prognosis
  • Reduce HS flares
  • Reduce recurrence after surgery

In 1 study, more than 33 percent of people with HS who had bariatric surgery had a decrease in HS symptoms after the surgery. Of those who lost more than 15 percent of their weight, nearly 50 percent had complete remission of HS, and another 20 percent had improvement.3

If you have HS, a weight-loss specialist may work with you to customize a diet and exercise program to make sure your nutritional needs are met.8

Stress management

Quitting smoking and weight loss benefit people with HS. However, coping with the added demands of those activities, while continuing to deal with the pain and strain of HS, may be stressful. Ironically, the disease may worsen from the stress of trying to relieve it. Stress management counseling may help.12

The disease poses challenges to the mental health and personal life of people with HS because of:12

  • Chronic pain
  • Appearance of lesions, abscesses, sinus tracts, and scars
  • Intimate body areas that are affected
  • Discharge of pus
  • Odor
  • Sexual dysfunction
  • Years of inadequate treatment before correct diagnosis
  • Reduced mobility
  • Work disability

High levels of anxiety and depression in people with HS are comparable to those in people with severe diseases as cancer, chronic obstructive pulmonary disease (COPD), stroke, and heart attack.13

It is important that dermatologists treating HS work with different healthcare specialists to also treat the mental and emotional aspects of HS. Efforts to treat those conditions should improve overall health outcomes.14

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