Weight Loss and Dietary Interventions for Hidradenitis Suppurativa: A Systematic Review

Abstract

Hidradenitis suppurativa (HS) is a common inflammatory disorder characterized by recurrent, painful, and malodorous abscesses and nodules predominantly in skin folds. HS is associated with substantial morbidity and poor quality of life. There are no curative therapies, and the only approved biologic drug has variable efficacy and requires high doses, making adjunct treatments crucial. An important risk factor for disease severity is obesity. Our primary objective was to conduct a systematic review examining weight loss and dietary interventions, in HS. Our secondary objective was to examine nutritional supplements in HS.A systematic literature search was conducted using Medline, EMBASE, and the Cochrane Database. We included all study types in adults (>18 years), with a minimum sample size of 5, examining the effects of any dietary or weight loss intervention on HS severity. Two authors screened n = 1279 articles of which 9 met inclusion criteria. All included studies were observational and all interventions were associated with various measures of decreased HS severity. Patient-controlled weight loss and bariatric surgery were associated with HS regression, though a subset of patients with significant increase in panniculi experienced exacerbations and required excision of excess skin. Diets demonstrating benefit eliminated dairy and brewer’s yeast. Nutritional supplements including zinc gluconate, vitamin D, and riboflavin had a suppressive, rather than curative, effect on HS lesions in single studies. Overall, the reviewed interventions show promise as potential adjunct treatments in a HS management plan. Prospective randomized controlled trials should validate these findings.

Alleviating and exacerbating foods in hidradenitis suppurativa

“…Chicken, fish, and red meat were considered to be alleviating. This may be due to the high zinc and vitamin B12 content of these foods, as recent systematic reviews indicate that supplementation of these micronutrients improves HS symptoms 11‐14 . Vitamin D supplementation may also lead to clinical HS improvement, and dairy products can be high in vitamin D 15 .…”

“…This may be due to the high zinc and vitamin B12 content of these foods, as recent systematic reviews indicate that supplementation of these micronutrients improves HS symptoms. [11][12][13][14] Vitamin D supplementation may also lead to clinical HS improvement, and dairy products can be high in vitamin D. 15 However, as dairy was frequently considered to be exacerbating in our study as well as in a prior report, 1 obtaining adequate vitamin D through supplementation rather than through dietary intake may be preferred in HS patients.…”

The most recent advances in understanding and managing hidradenitis suppurativa

“…Zinc was found to be at significantly lower serum levels in post-BS patients with HS compared to those patients with HS who had not undergone BS 27 . A recent systematic review also found that a subset of HS patients after BS had a significant increase in panniculus and experienced HS exacerbations in the excess panniculus, requiring excision of loose skin 28 . These results suggest that post-BS patients may represent a special cohort requiring further medical and surgical intervention to manage HS.…”

Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence

“…74 Overall, these associations suggest that a systemic proinflammatory state and localized infundibular keratinocyte dysregulation are potential predisposing factors to clinical disease. There are contradictory reports 76 pertaining to the benefit of withdrawing these predisposing factors (eg, cessation of smoking, weight loss) during established disease. These findings appear contradictory only if one holds the assumption that the initiating and perpetuating factors of clinical disease in hidradenitis suppurativa are one and the same.…”