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Treatment – Lifestyle Modifications

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

Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. 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.
  2. Jemec GBE. Clinical practice: hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi:10.1056/NEJMcp1014163.
  3. 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.
  4. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015 Jan;29(4):619-644. doi:10.1111/jdv.12966.
  5. Nazary M, van der Zee H, Prens E, et al., Pathogenesis and pharmacotherapy of hidradenitis suppurativa. Eur J Pharmacol. 2011 Dec 15;672(1-3):1-8. doi:10.1016/j.ejphar.2011.08.047.
  6. Vazquez BG , Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota, J Invest Dermatol. 2013;133(1):97-103. doi:10.1038/jid.2012.255.
  7. Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: an update on connecting the tracts. F1000Research. 2017 Jul 28;6(F1000 Faculty Rev):1272. doi:10.12688/11000research.11337.1.
  8. Collier E, Shi VY, Parvataneni RK, et al. Special considerations for women with hidradenitis suppurativa. Int J Womens Dermatol. 2020 Feb 19;6:85-88. doi:10.1016/j.ijwd.2020.02.005.
  9. Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017 Aug;153:760-764. doi:10.1001/jamadermatol.2017.0201.
  10. Calculate your body mass index. National Heart, Lung, and Blood Institute. Available at https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm. Accessed 8/28/2020.
  11. Tzellos T, Zouboulis CC. Review of comorbidities of hidradenitis suppurativa: implications for daily clinical practice. Dermatol Ther (Heidelb). 2020;10(1):63‐71.
  12. Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician. 2005 Oct 15;72(8):1547-1552.
  13. Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90(3):264-268.
  14. Machado MO, Stergiopoulos V, Maes M, et al. Depression and anxiety in adults with hidradenitis suppurativa: a systematic review and meta-analysis. JAMA Dermatol. 2019 Jun 5. doi:10.1001/jamadermatol.2019.0759.