Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that causes painful boil-like lumps under the skin. It most commonly affects areas where skin rubs together, like the armpits, groin, and under the breasts. HS is estimated to affect up to 4% of the population, and is 3 times more common in women than men.
Obesity and being overweight are known risk factors for developing HS. Some research has found that having a high body mass index (BMI) is associated with increased HS severity. This has led to the question of whether losing weight can improve HS symptoms.
The link between HS and obesity
Multiple studies have shown an association between obesity and HS:
- A meta-analysis of 18 studies found the prevalence of obesity was significantly higher in HS patients compared to the general population.
- In a study of 308 HS patients, 78% were overweight or obese.
- A study of 120 HS patients found that a higher BMI was associated with more widespread disease and more lesions.
The exact reason for the link between excess weight and HS is unclear. Some theories include:
- Friction between skin folds may trigger HS lesions in obese patients.
- Obesity causes a chronic low-grade inflammation that may promote HS.
- Obesity alters hormone levels like insulin, which can influence HS.
- The microbiome of obese patients may differ and promote HS.
Weight loss and HS severity
Given the association between obesity and HS, it logically follows that weight loss should improve HS symptoms. However, evidence on the effects of weight loss is limited.
Smaller observational studies have found:
- In one study of 10 obese HS patients who lost weight via bariatric surgery, 9 out of 10 experienced HS remission or improvement.
- A study of 30 HS patients who lost weight through dietary changes and exercise found their HS lesions and pain decreased.
However, larger and more rigorous studies are needed to confirm these findings. For example, one randomized controlled trial which assigned 24 obese HS patients to an intensive weight loss program or control group found no difference in HS severity between groups after 16 weeks.
Overall, most dermatologists and researchers believe weight loss should help reduce HS severity, but larger controlled studies are still needed.
Tips for losing weight with HS
For obese or overweight HS patients who want to lose weight, here are some tips that may help:
- Choose low-impact cardio like swimming or cycling to avoid rubbing skin folds.
- Wear moisture-wicking fabrics to keep skin dry during exercise.
- Try strength training to build muscle without increasing joint impact.
- Ask your doctor about compression garments to reduce rubbing and irritation.
- Adopt an anti-inflammatory diet high in plants, fish, and unsaturated fats.
- Consider intermittent fasting for weight loss under medical supervision.
- Join a support group to help stay motivated on your weight loss journey.
Losing even a moderate amount of weight, like 5-10% of your body weight, may be enough to see improvement in HS symptoms. Any amount of weight loss should be seen as a positive step forward.
The impact of bariatric surgery on HS
Bariatric or weight loss surgery is an option for some obese patients who have difficulty losing weight through diet and exercise alone. Types of bariatric surgery include:
- Gastric sleeve – Reduces stomach size
- Gastric bypass – Reroutes digestive system
- Gastric band – Uses adjustable band around stomach
Bariatric surgery can lead to significant weight loss, which may improve HS. Some key points about bariatric surgery and HS:
- Small studies show most HS patients experience improvement or remission after bariatric surgery.
- One study found gastric bypass led to greater improvement than gastric banding.
- Bariatric surgery may not lead to complete HS remission, just improvement.
- Patients may still need adjunct treatments like antibiotics after surgery.
- The rapid weight loss after surgery may temporarily worsen HS inflammation.
Overall, bariatric surgery appears beneficial for obese HS patients who qualify. However, patients should be prepared for the possibility that some symptoms may persist even after large weight loss.
Diet recommendations for HS patients
In addition to weight loss, following an HS-friendly diet may also help manage symptoms. Some dietary recommendations for HS patients include:
- Limiting dairy, gluten, refined carbs, and sugar
- Eating lots of fruits, vegetables, lean proteins, and anti-inflammatory fats
- Staying hydrated with water
- Limiting alcohol, which may trigger flares
- Avoiding foods that worsen symptoms individually
One small study found following an autoimmune protocol or paleo diet for 6 weeks reduced HS severity, likely by decreasing systemic inflammation. Working with a dietitian or nutritionist may help find the most effective dietary changes for each patient.
The role of supplements and over-the-counter therapies
Some HS patients find certain supplements or over-the-counter products can help minimize symptoms when combined with other treatments. Options to discuss with your doctor include:
- Turmeric or curcumin supplements to reduce inflammation
- Zinc supplements to promote wound healing
- Tea tree oil or oregano oil topicals to treat active lesions
- Probiotics to support the gut microbiome
- Light therapy devices to reduce inflammation
Keep in mind supplements are not well-studied for HS, and some options like vitamin D may not be effective based on current research. Work with your dermatologist to determine if any supplements or OTC therapies are worth trying.
Can cellulitis occur with HS?
Cellulitis is a bacterial skin infection that causes red, swollen, warm, and tender skin. It most often affects the lower legs, but can occur anywhere. HS lesions can become infected with bacteria and develop into cellulitis.
Signs that an HS lesion may be infected include:
- Increasing pain, swelling, warmth, and redness
- Red streaking around the lesion
- Fever and flu-like symptoms
- Pus or foul-smelling discharge
Cellulitis requires urgent medical treatment with antibiotics, as the infection can spread to the lymph nodes and bloodstream. Obese and overweight HS patients may be at increased risk for cellulitis around lesions in skin folds.
To prevent cellulitis infections:
- Keep HS lesions clean and covered until healed
- Use antiseptic wash on lesions daily
- Wear loose, breathable clothing
- Apply topical antibiotics prescribed by your doctor
- Get early treatment for any signs of infection
Promptly contacting your doctor at the first signs of infection can help avoid a full-blown cellulitis infection requiring hospitalization.
Stress management techniques for HS patients
Living with a chronic skin condition like HS can negatively impact quality of life and cause significant psychological stress. Studies show HS patients have higher rates of depression and anxiety.
Managing stress is important for overall health and may even help control HS flares. Some stress management techniques to try include:
- Counseling or therapy – Talking to a therapist can help develop coping strategies.
- Support groups – Connecting with others facing similar challenges provides support.
- Relaxation techniques – Activities like meditation, yoga, massage, etc can reduce stress.
- Cognitive behavioral therapy (CBT) – CBT can help change negative thought patterns.
- Lifestyle changes – Getting enough sleep, eating healthy, and exercising helps manage stress.
Learning to manage stress and difficult emotions around an HS diagnosis is an important part of self-care. Seeking professional help is encouraged to develop effective coping mechanisms.
Conclusion
The relationship between excess weight and HS provides hope that weight loss could improve symptoms. Small studies show bariatric surgery and dietary weight loss may reduce HS severity, but more research is still needed. Obese and overweight HS patients should work closely with their healthcare team to develop a comprehensive treatment plan, which may include weight loss strategies, medications, surgery, and stress management. With an individualized, multidisciplinary approach, significant improvement in HS is possible.