What To Eat & Avoid When You Have Hidradenitis Suppurativa?

Hidradenitis suppurativa is a type of chronic skin condition that causes small and painful bumps to form under the skin. These lumps or skin lesions develop due to inflammation and infection of the sweat glands and can vary in size from a pea to marble-sized lumps growing underneath the skin. These lumps can break open or form tunnels under the skin. Hidradenitis suppurativa tends to commonly develop in areas where the skin rubs together, such as the groin, armpits, buttocks, and breasts. The foods you eat may lead to a flare-up of Hidradenitis suppurativa, while certain foods can help reduce the skin inflammation. Maintaining a healthy diet can help decrease the skin flare-ups caused due to Hidradenitis suppurativa. Read on to find out about what to eat when you have Hidradenitis suppurativa.

Overview of Hidradenitis Suppurativa

Hidradenitis suppurativa is a type of chronic skin condition that causes small, painful lumps to develop underneath the skin.(1,2) Hidradenitis suppurativa is also known as acne inversa, and it commonly appears on the areas of the body where the skin rubs together, such as the underarms, breasts, buttocks, and groin.(3,4) Hidradenitis suppurativa causes inflammation of the skin with lesions or sores that may look like boils. The condition commonly develops after puberty and is believed to be a hereditary condition. Hidradenitis suppurativa is three times more likely to affect women than men.(5,6)

Hidradenitis suppurativa typically affects both sides of the body, and you are likely to develop bumps either in one place at one time or in several places at once. The first warning symptom of hidradenitis suppurativa is usually one painful bump that starts to get inflamed and lasts for a few days to months. These bumps can sometimes get infected, and when this happens, pockets tend to form underneath the skin and fill up with pus. These can smell bad when they burst open and can also leave scars.

The exact cause of hidradenitis suppurativa is still unclear, but it is believed to be related to your genes and environmental factors. There is no cure for hidradenitis suppurativa, but there are many ways to manage the symptoms and prevent a flare-up of the disease. Your doctor may prescribe treatments like antibiotics, laser treatments, or even surgery in severe cases.

It has been observed that hidradenitis suppurativa more commonly affects people who are obese or overweight. Studies have shown that losing some weight can have a significant effect on alleviating your symptoms.(7)

Hidradenitis suppurativa is also associated with smoking, eating unhealthy and junk foods, and metabolic syndrome. Metabolic syndrome is a collection of conditions that include high blood pressure and high blood sugar that increase the risk of heart disease.(8,9)

Your diet is known to have a huge impact on your flare-ups of Hidradenitis suppurativa. While certain foods help decrease skin inflammation and help balance hormonal problems, but at the same time, eating unhealthy foods can aggravate the condition. While making certain dietary changes have been found to dramatically improve the symptoms of hidradenitis suppurativa in some people, but it is important to know that there is no one type of diet that is recommended for treating this condition. Research on the exact impact of diet on hidradenitis suppurativa is still going on.(10)

Eating a healthy diet will help reduce your flare-ups. Here are some foods to eat and foods to avoid when you have hidradenitis suppurativa.

Foods That Help In Hidradenitis Suppurativa

Omega-3 Fatty Acids

Studies have found that foods rich in omega-3 fatty acids help reduce inflammation in the body.(20) Reduction of overall inflammation can help prevent or at least alleviate the symptoms of hidradenitis suppurativa and reduce the development of inflamed sores.

While more research is still needed to determine the benefits of omega-3 fatty acids for people with hidradenitis suppurativa, but it is always good to have foods rich in omega-3 fatty acids. This is because these healthy fats are also equally beneficial for your heart, brain, and blood vessels. Some good sources of omega-3 fatty acids include:

Foods Rich In Fiber

Foods that are rich in fiber help the body balance the levels of blood sugar and also controls hormone levels. Fiber helps you feel full faster and also reduces unhealthy food cravings. This can also help you maintain a healthy weight.(21)

People with hidradenitis suppurativa should try to replace simple and sugary carbohydrates with complex carbs and whole foods like:

  • Beans
  • Lentils
  • Fresh and frozen vegetables
  • Fresh and frozen fruits
  • Fresh and dried herbs
  • Brown rice
  • Oats
  • Bran
  • Barley
  • Quinoa
  • Couscous

Natural Sweeteners

It is still possible to continue enjoying your favorite desserts and sweet beverages. Try to choose those foods and drinks that are made with natural sweeteners. These do not increase your blood sugar levels significantly. At the same time, deciding to replace sugary drinks with plain or sparkling water, reducing the amount of sweeteners you add to your beverages and foods, and reducing the consumption of foods high in added sugar like cakes, candy, and sports drinks, can all help reduce the severity of your symptoms and prevent a flare-up of your condition.

Using natural sweeteners like stevia and monk fruit in small amounts can help you replace table sugar and other high-calorie sweeteners in your daily diet.

Foods To Avoid When You Have Hidradenitis Suppurativa Flare-Up

Sugary and Refined Foods

Sugary foods, along with refined and simple carbohydrates, are known to cause an increase in blood glucose. According to studies, this can cause further inflammation and symptoms.(11) Avoiding simple carbohydrates and foods high in added sugar can help prevent a flare-up of hidradenitis suppurativa.(12) These include:

  • Corn syrup
  • High-fructose corn syrup
  • White flour
  • Table sugar
  • Noodles
  • Boxed cereals
  • Soda and other sugary beverages like fruit juice
  • Rice, pasta, or bread made from white flour
  • Cake, doughnuts, and pastries
  • Potato chips
  • Biscuits and cookies
  • Crackers made from refined flour
  • Candy
  • Sugary protein bars
  • Chocolate

Milk and Dairy Products

Milk and dairy products can increase the levels of certain hormones in the body that can cause a flare-up of your symptoms. Cow’s milk is also known to cause inflammation.(13) Studies have shown that eliminating or restricting the intake of dairy products can help in reducing the symptoms of hidradenitis suppurativa in some people.(11)

Dairy products that should be limited or eliminated altogether include:

  • Cow’s milk
  • Cottage cheese
  • Cheese
  • Cream cheese
  • Yogurt
  • Butter
  • Buttermilk
  • Ice cream

Brewer’s Yeast

A small research study discovered that brewer’s yeast could be a potential trigger for the symptoms of hidradenitis suppurativa in some people. This is likely because this type of yeast causes a reaction in the immune system.(14)

Other studies have also found that brewer’s yeast might trigger the symptoms in people who have a wheat intolerance.

This is why you should make it a habit to check any food labels and avoid anything that contains brewer’s yeast. Some of the everyday items that have brewer’s yeast include:

  • Beer
  • Wine
  • Some soy sauces
  • Fermented spreads
  • Some stock cubes
  • Some bread, pizza, and cakes
  • Some canned or dried soups
  • Some dips and gravies
  • Some health supplements
  • Some salad dressings and vinegars

Other Food Items

Even though there have been no clinical trials done to date, it has been noticed that some people with hidradenitis suppurativa experience relief in their symptoms by stopping the intake of nightshades.(15) Nightshades are a class of plants that include vegetables like:

Many types of herbs and spices are also derived from nightshades, including crushed red pepper, chili powder, cayenne pepper, and paprika. However, black and white pepper are not part of the nightshade family as they are derived from peppercorns.

There are many condiments and other common food items that contain nightshade vegetables as ingredients. These may include salsa, marinara sauce, ketchup, and hot sauce.

In 2017 and 2019, research found that people who followed a diet that eliminated nightshades and many other foods like dairy and grains experienced more relief and reduced symptoms in autoimmune disorders like Hashimoto’s thyroiditis and inflammatory bowel disease (IBD).(16,17)

Research has also discovered that hidradenitis suppurativa is closely associated with various autoimmune disorders, including inflammatory bowel disease and lupus.(18) This is why experts believe that the immune system is involved in causing hidradenitis suppurativa.(19)

However, since there is a lack of research studies that investigate the association between consumption of nightshade vegetables and a flare-up of symptoms in people with hidradenitis suppurativa, it is still unclear whether this dietary change can benefit all people with this disease.

Other factors that can cause a flare-up or worsen your symptoms of hidradenitis suppurativa include:

  • Tobacco use or smoking cigarette
  • Obesity or weight gain
  • Intake of foods that contain gluten, especially if you are gluten intolerant

Can You Follow A Diet With Hidradenitis Suppurativa?

Over the years, numerous diets have become popular for people with hidradenitis suppurativa. These include the Whole30 diet and the autoimmune protocol diet.
Many adults with hidradenitis suppurativa have reported experiencing good results after trying out these diets. This is probably because both these diets focus on restricting foods like refined carbs and dairy products.

However, there are many other diets that are overly restrictive, and there is no scientific evidence to show that the diet works for hidradenitis suppurativa.(22)

What data is known is that following an anti-inflammatory diet like the Mediterranean diet can be helpful in alleviating the symptoms of hidradenitis suppurativa while also improving your general health.(23) A 2019 study found that following a Mediterranean diet that is rich in antioxidant foods can help improve the severity of symptoms in people with hidradenitis suppurativa.(24)

Overall, eating a healthy diet that is rich in anti-inflammatory foods and restricting the intake of processed foods is going to benefit people with hidradenitis suppurativa.

Can Supplements Help Hidradenitis Suppurativa?

There is very little research to show whether taking certain vitamins and mineral supplements can help people with hidradenitis suppurativa. One study found that taking high-dose vitamin B12 supplements can help improve the symptoms of hidradenitis suppurativa in people.(25)

Another research found that people with hidradenitis suppurativa are prone to having low blood levels of zinc. The study found that taking zinc supplements can cause a partial or complete remission in people who have not responded to other treatments for hidradenitis suppurativa.(26)

Studies have also found that along with zinc, people with hidradenitis suppurativa are also more prone to having low levels of vitamin D.(13) Supplementation of vitamin D can also help reduce the severity of symptoms.

If you want to try taking some supplements for improving your symptoms of hidradenitis suppurativa, talking to your doctor about the proper dosage and any potential side effects is the right choice.

Conclusion

Studies have found that having obesity or being overweight is closely linked to hidradenitis suppurativa. There is no cure for hidradenitis suppurativa, and medical treatment along with a healthy lifestyle can help reduce the symptoms and prevent a flare-up of the condition. You should also talk with your doctor to come up with a weight loss plan that is right for you. Since your diet is closely linked with flare-ups of hidradenitis suppurativa, it is necessary to keep track of what foods trigger your symptoms.

Along with a healthy lifestyle, your doctor is also going to prescribe a treatment plan for you. Treatments for hidradenitis suppurativa include medication, protective silicone bandages, laser therapy, and surgery in severe cases. Bandages may help alleviate skin irritation, swelling, and pain.

Further research is still needed to determine how your diet can help in the treatment of hidradenitis suppurativa. Following an elimination diet can help you understand which foods are a potential trigger for you. Consulting a dietitian or nutritionist can help you come up with a diet plan for hidradenitis suppurativa. Remember that your dietary choices have to become a daily part of your life, not just a temporary diet to try out and leave. Following the dietary recommendations given by your doctor or dietitian can help you reduce the symptoms of hidradenitis suppurativa.

References:

  1. Jemec, G.B., 2012. Hidradenitis suppurativa. New England Journal of Medicine, 366(2), pp.158-164.
  2. Revuz, J., 2009. Hidradenitis suppurativa. Journal of the European Academy of Dermatology and Venereology, 23(9), pp.985-998.
  3. Alikhan, A., Lynch, P.J. and Eisen, D.B., 2009. Hidradenitis suppurativa: a comprehensive review. Journal of the American Academy of Dermatology, 60(4), pp.539-561.
  4. Jemec, G.B., Heidenheim, M. and Nielsen, N.H., 1996. The prevalence of hidradenitis suppurativa and its potential precursor lesions. Journal of the American Academy of Dermatology, 35(2), pp.191-194.
  5. Sabat, R., Jemec, G.B., Matusiak, Ł., Kimball, A.B., Prens, E. and Wolk, K., 2020. Hidradenitis suppurativa. Nature Reviews Disease Primers, 6(1), pp.1-20.
  6. Dufour, D.N., Emtestam, L. and Jemec, G.B., 2014. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgraduate medical journal, 90(1062), pp.216-221.
  7. KRoMAnn, C.B., IBlER, K.S., KRISTIAnSEn, V.B. and Jemec, G.B., 2014. The influence of body weight on the prevalence and severity of hidradenitis suppurativa. Acta dermato-venereologica, 94(5), pp.553-557.
  8. Gold, D.A., Reeder, V.J., Mahan, M.G. and Hamzavi, I.H., 2014. The prevalence of metabolic syndrome in patients with hidradenitis suppurativa. Journal of the American Academy of Dermatology, 70(4), pp.699-703.
  9. Sartorius, K., Emtestam, L., Jemec, G.B.E. and Lapins, J., 2009. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. British Journal of Dermatology, 161(4), pp.831-839.
  10. Smith, M.K., Nicholson, C.L., Parks-Miller, A. and Hamzavi, I.H., 2017. Hidradenitis suppurativa: an update on connecting the tracts. F1000Research, 6.
  11. Kim, Y., Chen, J., Wirth, M.D., Shivappa, N. and Hebert, J.R., 2018. Lower dietary inflammatory index scores are associated with lower glycemic index scores among college students. Nutrients, 10(2), p.182.
  12. Danby, F.W., 2015. Diet in the prevention of hidradenitis suppurativa (acne inversa). Journal of the American Academy of Dermatology, 73(5), pp.S52-S54.
  13. Choi, F., Lehmer, L., Ekelem, C. and Mesinkovska, N.A., 2020. Dietary and metabolic factors in the pathogenesis of hidradenitis suppurativa: a systematic review. International journal of dermatology, 59(2), pp.143-153.
  14. Cannistrà, C., Finocchi, V., Trivisonno, A. and Tambasco, D., 2013. New perspectives in the treatment of hidradenitis suppurativa: Surgery and brewer’s yeast–exclusion diet. Surgery, 154(5), pp.1126-1130.
  15. Silfvast‐Kaiser, A., Youssef, R. and Paek, S.Y., 2019. Diet in hidradenitis suppurativa: a review of published and lay literature. International journal of dermatology, 58(11), pp.1225-1230.
  16. Konijeti, G.G., Kim, N., Lewis, J.D., Groven, S., Chandrasekaran, A., Grandhe, S., Diamant, C., Singh, E., Oliveira, G., Wang, X. and Molparia, B., 2017. Efficacy of the autoimmune protocol diet for inflammatory bowel disease. Inflammatory bowel diseases, 23(11), pp.2054-2060.
  17. Abbott, R.D., Sadowski, A. and Alt, A.G., 2019. Efficacy of the autoimmune protocol diet as part of a multi-disciplinary, supported lifestyle intervention for Hashimoto’s thyroiditis. Cureus, 11(4).
  18. David, C.B., Bragazzi, N.L., Watad, A., Sharif, K., Whitby, A., Amital, H. and Adawi, M., 2018. Hidradenitis suppurativa associated with systemic lupus erythematosus: A case report. Medicine, 97(12).
  19. Byrd, A.S., Carmona-Rivera, C., O’Neil, L.J., Carlucci, P.M., Cisar, C., Rosenberg, A.Z., Kerns, M.L., Caffrey, J.A., Milner, S.M., Sacks, J.M. and Aliu, O., 2019. Neutrophil extracellular traps, B cells, and type I interferons contribute to immune dysregulation in hidradenitis suppurativa. Science translational medicine, 11(508).
  20. Yates, C.M., Calder, P.C. and Rainger, G.E., 2014. Pharmacology and therapeutics of omega-3 polyunsaturated fatty acids in chronic inflammatory disease. Pharmacology & therapeutics, 141(3), pp.272-282.
  21. Molnar, J., Mallonee, C.J., Stanisic, D., Homme, R.P., George, A.K., Singh, M. and Tyagi, S.C., 2020. Hidradenitis Suppurativa and 1-Carbon Metabolism: Role of Gut Microbiome, Matrix Metalloproteinases, and Hyperhomocysteinemia. Frontiers in Immunology, 11, p.1730.
  22. Fenton, T.R. and Fenton, C.J., 2016. Paleo diet still lacks evidence. The American journal of clinical nutrition, 104(3), pp.844-844.
  23. Barrea, L., Fabbrocini, G., Annunziata, G., Muscogiuri, G., Donnarumma, M., Marasca, C., Colao, A. and Savastano, S., 2019. Role of nutrition and adherence to the mediterranean diet in the multidisciplinary approach of hidradenitis suppurativa: evaluation of nutritional status and its association with severity of disease. Nutrients, 11(1), p.57.
  24. Barrea, L., Fabbrocini, G., Annunziata, G., Muscogiuri, G., Donnarumma, M., Marasca, C., Colao, A. and Savastano, S., 2019. Role of nutrition and adherence to the mediterranean diet in the multidisciplinary approach of hidradenitis suppurativa: evaluation of nutritional status and its association with severity of disease. Nutrients, 11(1), p.57.
  25. Mortimore, M. and Florin, T.H., 2010. A role for B12 in inflammatory bowel disease patients with suppurative dermatoses? An experience with high dose vitamin B12 therapy. Journal of Crohn’s and Colitis, 4(4), pp.466-470.
  26. Poveda, I., Vilarrasa, E., Martorell, A., García-Martínez, F.J., Segura, J.M., Hispán, P., Sánchez-Payá, J., Álvarez, P.J., González, I. and Pascual, J.C., 2018. Serum zinc levels in hidradenitis suppurativa: A case–control study. American journal of clinical dermatology, 19(5), pp.771-777.

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