Natural Therapies for Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a complex chronic inflammatory skin condition. Managing it effectively involves considering many factors like inflammation, immune system, nutrition, metabolism, lifestyle, and diet.
Risk Factors for Hidradenitis Suppurativa
Given the complexity of HS, at our clinic we test both common and less traditional risk factors so that any potential underlying issues that could be exacerbating the condition can be found and treated accordingly. It is important to test before treating because dosing should be tailored based on the blood work. For example, if a person who is already high in vitamin D begins supplementing high dose vitamin D this can lead to serious side effects and toxicity - read more here.
Some of these risk factors that can be tested include:
Inflammation - A 2022 study found certain inflammatory markers are commonly elevated in the blood of those with HS and appear to be related to symptom severity.[1]
Vitamin D - A 2022 study found that all patients with HS were deficient in vitamin D.[2] A 2021 study found those with low levels of vitamin D have more severe symptoms.[3]
Immune testing - A 2022 study found that those with high levels of IgG immunoglobulin had more severe HS symptoms.[4]
Zinc - A 2018 study found that those with HS have six times the risk of being deficient in zinc compared to those without HS.[5] Furthermore, those with the lowest zinc levels had the most severe symptoms.
Iron - Although iron has not been yet confirmed to be related to symptom severity, a 2020 study found that those with HS have 40% lower iron levels.[6]
Hemoglobin - A 2019 study found that patients with HS who have lower levels of hemoglobin (a sign of anemia) have higher levels of inflammation.[7] Furthermore, another 2019 study found that iron supplementation in those with anemia led to reduced levels of inflammation.[8]
Screening for inflammatory bowel disease (IBD) - A 2019 study found that patients with HS are at increased risk of IBD.[9] IBD can affect a person’s ability to absorb iron, which can lead to anemia, which may be associated with higher inflammation, as mentioned above.
Fasting insulin - A 2020 study found that the risk of insulin resistance is nearly six times higher in those with HS.[10]
Blood sugar - A 2021 study found that those with higher blood sugar levels, as measured by HbA1c had more severe symptoms[11]
Alternative Names
HS is also known as acne inversus.
Natural Therapies for Hidradenitis suppurativa
Our approach is tailored according to the blood work. For example, if IgG (a specific immune marker) levels are high, then we may recommend addressing other factors that can cause high IgG, such as alcohol intake, blood pressure, and stress levels (2021 study).[12] If insulin resistance is found then natural therapies that reduce insulin resistance have been shown to help reduce symptom severity in those with HS (2020 study).[13]
If nutrient deficiencies are found then those can be addressed and possibly improve symptoms as well. For example, zinc is commonly deficient in those with HS and a 2020 study found that those supplementing zinc remained symptom-free without relapse nearly four times as long (20 weeks) compared to the placebo group (5.4 weeks).[14] There were also less flares, lower flare severity and lower levels of pain. There are many ways zinc seems to impact those with HS - a 2014 study found that zinc reduces complement[15], an inflammatory marker related to insulin resistance that tends to be high in those with HS (2018 study).[16] All this being said, keep in mind that it is important to test before supplementing as too much zinc can also be dangerous and increase risk of side effects and other conditions.
Aside from blood work - we also look at diet and lifestyle changes that can be made to help improve the metabolism and immunity. Specific dietary approaches have been studied and shown to benefit those with HS.
All of the above is just a small portion of the many factors we consider and treat at our clinic. For difficult complex conditions it usually requires a complex approach that looks at all aspects of a person’s life - from diet, lifestyle, immunity, inflammation, metabolism and more.
References
[1] Gibson RS, Porter ML, Kimball AB. Erythrocyte sedimentation rate, rather than C-reactive protein, may be the preferred biomarker for hidradenitis suppurativa. JAAD Int. 2022 May 19;8:47-48. doi: 10.1016/j.jdin.2022.04.005. PMID: 35620323; PMCID: PMC9127563.
[2] Seetan K, Eldos B, Saraireh M, Omari R, Rubbai Y, Jayyusi A, Abu Jubran M. Prevalence of low vitamin D levels in patients with Hidradenitis suppurativa in Jordan: A comparative cross-sectional study. PLoS One. 2022 Mar 18;17(3):e0265672. doi: 10.1371/journal.pone.0265672. PMID: 35303020; PMCID: PMC8932615.
[3] Moltrasio C, Tricarico PM, Genovese G, Gratton R, Marzano AV, Crovella S. 25-Hydroxyvitamin D serum levels inversely correlate to disease severity and serum C-reactive protein levels in patients with hidradenitis suppurativa. J Dermatol. 2021 May;48(5):715-717. doi: 10.1111/1346-8138.15797. Epub 2021 Feb 24. PMID: 33624897.
[4] Mintoff D, Borg I, Pace NP. Serum Immunoglobulin G Is a Marker of Hidradenitis Suppurativa Disease Severity. Int J Mol Sci. 2022 Nov 9;23(22):13800. doi: 10.3390/ijms232213800. PMID: 36430277; PMCID: PMC9698525.
[5] Poveda I, Vilarrasa E, Martorell A, García-Martínez FJ, Segura JM, Hispán P, Sánchez-Payá J, Álvarez PJ, González I, Pascual JC. Serum Zinc Levels in Hidradenitis Suppurativa: A Case-Control Study. Am J Clin Dermatol. 2018 Oct;19(5):771-777. doi: 10.1007/s40257-018-0374-5. PMID: 30043129.
[6] Ponikowska M, Matusiak L, Kasztura M, Jankowska EA, Szepietowski JC. Deranged Iron Status Evidenced by Iron Deficiency Characterizes Patients with Hidradenitis Suppurativa. Dermatology. 2020;236(1):52-58. doi: 10.1159/000505184. Epub 2020 Jan 10. PMID: 31927542.
[7] Huang CM, Lowes MA, Cserti C, Alavi A. Hemoglobin Levels and Serum C-Reactive Protein in Patients With Moderate to Severe Hidradenitis Suppurativa. J Cutan Med Surg. 2019 Sep/Oct;23(5):501-506. doi: 10.1177/1203475419858963. Epub 2019 Jun 28. PMID: 31253065.
[8] Iron Supplementation Improves Cardiovascular Outcomes in Patients with Heart Failure
Author links open overlay panelXiang Zhou MD, PhD a, Weiting Xu MD a, Youjia Xu MD b, Zhiyuan Qian MD. Link.
[9] Association of Hidradenitis Suppurativa With Inflammatory Bowel Disease A Systematic Review and Meta-analysis
Wei-Ti Chen, MD1,2; Ching-Chi Chi, MD, MMS, DPhil2,3 Author Affiliations Article Information JAMA Dermatol. 2019;155(9):1022-1027. doi:10.1001/jamadermatol.2019.0891
[10] Özkur E, Erdem Y, Altunay İK, Demir D, Dolu NÇ, Serin E, Çerman AA. Serum irisin level, insulin resistance, and lipid profiles in patients with hidradenitis suppurativa: a case-control study. An Bras Dermatol. 2020 Nov-Dec;95(6):708-713. doi: 10.1016/j.abd.2020.04.009. Epub 2020 Sep 11. PMID: 33008659; PMCID: PMC7672402.
[11] Sánchez-Díaz M, Salvador-Rodríguez L, Montero-Vílchez T, Martínez-López A, Arias-Santiago S, Molina-Leyva A. Cumulative Inflammation and HbA1c Levels Correlate with Increased Intima-Media Thickness in Patients with Severe Hidradenitis Suppurativa. J Clin Med. 2021 Nov 9;10(22):5222. doi: 10.3390/jcm10225222. PMID: 34830503; PMCID: PMC8625299.
[12] Khan SR, van der Burgh AC, Peeters RP, van Hagen PM, Dalm VASH, Chaker L. Determinants of Serum Immunoglobulin Levels: A Systematic Review and Meta-Analysis. Front Immunol. 2021 Apr 7;12:664526. doi: 10.3389/fimmu.2021.664526. PMID: 33897714; PMCID: PMC8058410.
[13] Donnarumma M, Marasca C, Palma M, Vastarella M, Annunziata MC, Fabbrocini G. An oral supplementation based on myo-inositol, folic acid and liposomal magnesium may act synergistically with antibiotic therapy and can improve metabolic profile in patients affected by Hidradenitis suppurativa: our experience. G Ital Dermatol Venereol. 2020 Dec;155(6):749-753. doi: 10.23736/S0392-0488.18.06012-1. Epub 2018 Sep 20. PMID: 30249083.
[14] Molinelli E, Brisigotti V, Campanati A, Sapigni C, Giacchetti A, Cota C, Offidani A. Efficacy of oral zinc and nicotinamide as maintenance therapy for mild/moderate hidradenitis suppurativa: A controlled retrospective clinical study. J Am Acad Dermatol. 2020 Aug;83(2):665-667. doi: 10.1016/j.jaad.2020.04.092. Epub 2020 Apr 24. PMID: 32339699.
[15] Smailhodzic D, van Asten F, Blom AM, Mohlin FC, den Hollander AI, van de Ven JP, van Huet RA, Groenewoud JM, Tian Y, Berendschot TT, Lechanteur YT, Fauser S, de Bruijn C, Daha MR, van der Wilt GJ, Hoyng CB, Klevering BJ. Zinc supplementation inhibits complement activation in age-related macular degeneration. PLoS One. 2014 Nov 13;9(11):e112682. doi: 10.1371/journal.pone.0112682. PMID: 25393287; PMCID: PMC4231060.