Diet, Weight Loss May Improve Hidradenitis Suppurativa Symptoms

Disease severity correlates with obesity and the prevalence of hidradenitis suppurativa in obesity has been estimated to be up to 18%.

There is an overall lack of sufficient evidence regarding the effects of diet and exercise on the disease course of hidradenitis suppurativa (HS), according to results of a systematic review published in American Journal of Clinical Dermatology.

Researchers from the University of Missouri searched publication databases through October 2022 for case-control, cohort, and randomized controlled studies evaluating the efficacy of weight loss and diet in HS. A total of 15 articles were discussed.

Results from 1 study found that weight loss of at least 22.7 kg in those who were obese, particularly among women, associated with beneficial subjective HS severity and Hurley stage outcomes. Another study reported that most patients (68.6%) who have substantial weight loss after bariatric surgery (BS) had resolution or reduction of symptoms. However, a small proportion of patients (11%) had an increase in active eruption sites, highlighting the multifactorial relationship between HS and weight loss.

Conversely, another study reported that most patients (83%) with past exposure to BS developed HS after their surgery.

Concrete recommendations that can be given to patients with some level of confidence include encouraging weight loss for symptom improvement…

In 6 studies, the effects of differing dietary interventions were evaluated. Dietary components such as low-carbohydrate diets, Paleo diets, anti-inflammatory diets, and the Mediterranean diet were associated with improvements to subjective HS severity outcomes. One study that focused on HS during Ramadan fasting reported that fasting every day from dawn to sunset improved the number of abscesses and draining fistulas and half of patients maintained these trends 1 month after the end of Ramadan.

Results from one study found that some patients with HS had substantially lower levels of anti-Saccharomyces cerevisiae antigen (ASCA) immunoglobulin (Ig)G than the general population (£10 vs approximately 40 U/mL), respectively. These patients were placed on brewer’s and baker’s yeast-free diets. The diet was associated with clinical symptom stabilization and skin lesion regression with immediate recurrence after diet termination.

The evidence of supplement or micronutrient interventions included improvements associated with zinc gluconate and vitamin D supplementation.

Study authors conclude, “Concrete recommendations that can be given to patients with some level of confidence include encouraging weight loss for symptom improvement, particularly if the patient is female and the BMI is greater than 30, encouraging strong adherence to the Mediterranean diet, and minimizing sugar, dairy, and simple carbohydrates. […] Clinicians and researchers should strive to further define these relationships so that we may improve the outcomes of patients struggling with this debilitating disease.”


Weber I, Giefer J, Martin KL. Effects of exercise and dietary modifications on hidradenitis suppurativa: a systematic review. Am J Clin Dermatol. Published online February 9, 2023. doi:10.1007/s40257-023-00756-w