Nutrition Education Toolbox for Hidradenitis Suppurativa

Main Article Content

Jennifer Fernandez
Joi Lenczowski
Jennifer Hsiao
Vivian Shi


Hidradenitis suppurativa, Nutrition, Diet, Food


Diet has been shown to influence disease activity in hidradenitis suppurativa (HS). Modification of dietary intake is the most commonly used lifestyle intervention in HS, and patients frequently report HS improvement after implementing dietary changes. Providing nutrition education may be perceived as not feasible within the time constraints of an outpatient office visit, and many physicians may also not feel equipped to do this. In addition, most insurances have limited coverage for nutrition visits. However, dietary changes may be employed as a low-cost adjunctive treatment option that can be combined with conventional medical treatment to mitigate HS symptoms. Though dietary modification has been increasingly recognized as a commonly used and influential factor in HS management, there is no comprehensive HS nutritional guide. Herein, we provide tools for both physicians and patients to facilitate evidence-based nutrition education in HS through collaboration with dermatologists specializing in HS, a registered dietitian, and a culinary specialist.


1. Dempsey A, Butt M, Kirby JS. Prevalence and Impact of Dietary Avoidance among Individuals with Hidradenitis Suppurativa. Dermatology. Published online November 1, 2019:1-7. doi:10.1159/000503063

2. Fernandez JM, Marr KD, Hendricks AJ, et al. Alleviating and exacerbating foods in hidradenitis suppurativa. Dermatologic Therapy. Published online September 11, 2020. doi:10.1111/dth.14246

3. Damiani, Mahroum, Pigatto, et al. The Safety and Impact of a Model of Intermittent, Time-Restricted Circadian Fasting (“Ramadan Fasting”) on Hidradenitis Suppurativa: Insights from a Multicenter, Observational, Cross-Over, Pilot, Exploratory Study. Nutrients. 2019;11(8):1781. doi:10.3390/nu11081781

4. Aboud C, Zamaria N, Cannistrà C. Treatment of hidradenitis suppurativa: Surgery and yeast (Saccharomyces cerevisiae)–exclusion diet. Results after 6 years. Surgery. 2020;167(6):1012-1015. doi:10.1016/j.surg.2019.12.015

5. Price KN, Thompson AM, Rizvi O, et al. Complementary and Alternative Medicine Use in Patients With Hidradenitis Suppurativa. JAMA Dermatol. Published online January 29, 2020. doi:10.1001/jamadermatol.2019.4595

6. Silfvast‐Kaiser A, Youssef R, Paek SY. Diet in hidradenitis suppurativa: a review of published and lay literature. Int J Dermatol. 2019;58(11):1225-1230. doi:10.1111/ijd.14465

7. Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). Journal of the American Academy of Dermatology. 2015;73(5):S52-S54. doi:10.1016/j.jaad.2015.07.042

8. C.-W.Yu C, Cook MG. Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands. Br J Dermatol. 1990;122(6):763-769. doi:10.1111/j.1365-2133.1990.tb06264.x

9. Danby FW. Turning acne on/off via mTORC1. Experimental Dermatology. 2013;22(7):505-506. doi:10.1111/exd.12180

10. Melnik BC, Zouboulis CC. Potential role of FoxO1 and mTORC1 in the pathogenesis of Western diet-induced acne. Exp Dermatol. 2013;22(5):311-315. doi:10.1111/exd.12142

11. Esposito K, Nappo F, Marfella R, et al. Inflammatory Cytokine Concentrations Are Acutely Increased by Hyperglycemia in Humans: Role of Oxidative Stress. Circulation. 2002;106(16):2067-2072. doi:10.1161/01.CIR.0000034509.14906.AE

12. Ricker MA, Haas WC. Anti-Inflammatory Diet in Clinical Practice: A Review. Nutr Clin Pract. 2017;32(3):318-325. doi:10.1177/0884533617700353

13. Aljada A, Friedman J, Ghanim H, et al. Glucose ingestion induces an increase in intranuclear nuclear factor κB, a fall in cellular inhibitor κB, and an increase in tumor necrosis factor α messenger RNA by mononuclear cells in healthy human subjects. Metabolism. 2006;55(9):1177-1185. doi:10.1016/j.metabol.2006.04.016

14. Simopoulos AP. Omega-6/Omega-3 Essential Fatty Acid Ratio and Chronic Diseases. Food Reviews International. 2004;20(1):77-90. doi:10.1081/FRI-120028831

15. Enos RT, Davis JM, Velázquez KT, et al. Influence of dietary saturated fat content on adiposity, macrophage behavior, inflammation, and metabolism: composition matters. J Lipid Res. 2013;54(1):152-163. doi:10.1194/jlr.M030700

16. Binger KJ, Gebhardt M, Heinig M, et al. High salt reduces the activation of IL-4– and IL-13–stimulated macrophages. Journal of Clinical Investigation. 2015;125(11):4223-4238. doi:10.1172/JCI80919

17. Wilck N, Matus MG, Kearney SM, et al. Salt-responsive gut commensal modulates TH17 axis and disease. Nature. 2017;551(7682):585-589. doi:10.1038/nature24628

18. Vendrell J, Broch M, Vilarrasa N, et al. Resistin, Adiponectin, Ghrelin, Leptin, and Proinflammatory Cytokines: Relationships in Obesity. Obesity Research. 2004;12(6):962-971. doi:10.1038/oby.2004.118

19. Caër C, Rouault C, Le Roy T, et al. Immune cell-derived cytokines contribute to obesity-related inflammation, fibrogenesis and metabolic deregulation in human adipose tissue. Sci Rep. 2017;7(1):3000. doi:10.1038/s41598-017-02660-w

20. Schrader AMR, Deckers IE, Van Der Zee HH, Boer J, Prens EP. Hidradenitis suppurativa: A retrospective study of 846 Dutch patients to identify factors associated with disease severity. Journal of the American Academy of Dermatology. 2014;71(3):460-467. doi:10.1016/j.jaad.2014.04.001

21. Boer J. Resolution of hidradenitis suppurativa after weight loss by dietary measures, especially on frictional locations. Journal of the European Academy of Dermatology and Venereology. 2016;30(5):895-896. doi:10.1111/jdv.13059

22. Kromann C, Ibler K, Kristiansen V, Jemec G. The Influence of Body Weight on the Prevalence and Severity of Hidradenitis Suppurativa. Acta Derm Venerol. 2014;94(5):553-557. doi:10.2340/00015555-1800

23. Kohorst JJ, Kimball AB, Davis MDP. Systemic associations of hidradenitis suppurativa. Journal of the American Academy of Dermatology. 2015;73(5):S27-S35. doi:10.1016/j.jaad.2015.07.055

24. Sabat R, Chanwangpong A, Schneider-Burrus S, et al. Increased Prevalence of Metabolic Syndrome in Patients with Acne Inversa. Bruggemann H, ed. PLoS ONE. 2012;7(2):e31810. doi:10.1371/journal.pone.0031810

25. Kouris A, Platsidaki E, Christodoulou C, et al. Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa. Dermatology. 2016;232(6):687-691. doi:10.1159/000453355

26. Riis P, Vinding G, Ring H, Jemec G. Disutility in Patients with Hidradenitis Suppurativa: A Cross-sectional Study Using EuroQoL-5D. Acta Dermato Venereologica. 2016;96(2):222-226. doi:10.2340/00015555-2129

27. Barrea L, Fabbrocini G, Annunziata G, et al. 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. 2019;11(1):57. doi:10.3390/nu11010057

28. Cannistrà C, Finocchi V, Trivisonno A, Tambasco D. New perspectives in the treatment of hidradenitis suppurativa: Surgery and brewer’s yeast–exclusion diet. Surgery. 2013;154(5):1126-1130. doi:10.1016/j.surg.2013.04.018

29. Mahan LK, Escott-Stump S, Raymond JL, Krause MV. Krause’s Food & the Nutrition Care Process - E-Book. Vol Thirteenth edition. Saunders; 2012.

30. Pronsky ZM, Crowe JP. Food Medication Interactions, 16th Edition. Journal of Pharmacy Technology. 2010;26(6):391-392. doi:10.1177/875512251002600616

31. Pereira MA, Jacobs DR, Pins JJ, et al. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. The American Journal of Clinical Nutrition. 2002;75(5):848-855. doi:10.1093/ajcn/75.5.848

32. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 2015;8th Edition:144.

33. Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72(1):30-43. doi:10.1038/ejcn.2017.58

34. U.S Department of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program (SNAP). Published online Accessed 18-Dec-19.

35. McMillan K. Hidradenitis Suppurativa: Number of Diagnosed Patients, Demographic Characteristics, and Treatment Patterns in the United States. American Journal of Epidemiology. 2014;179(12):1477-1483. doi:10.1093/aje/kwu078

36. Ellis E. RDNs and Medical Nutrition Therapy Services. Published October 8, 2018. Accessed February 29, 2020.

37. Academy of Nutrition and Dietetics. Medicaid and RDNs.