INTRODUCTION
Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin condition that is characterized by keratin and bacterial accumulation in hair follicles, leading to follicular rupture, abscess formation, and scarring. While the exact pathogenesis of HS is not fully understood, it is known to be multifactorial, influenced by both genetic and environmental factors. Patients with HS have higher amounts of proinflammatory cytokines, including TNF-alpha, IL-1β, and IL-17, which suggests a systemic inflammatory component.1 Emerging evidence suggests that diet may contribute to this systemic inflammation. Prior literature has explored this link and identified possible dietary components that may lead to the development of HS. Additionally, other works report possible foods that may exacerbate HS. Although these reviews have addressed the connection between diet and HS, many were published several years ago. As new dietary trends emerge and updated studies are conducted, a synthesis of recent findings is warranted. This article aims to evaluate current evidence on the relationship between diet and HS and to highlight areas for future investigation.
MATERIALS AND METHODS
To identify and synthesize emerging data investigating diet and HS, we conducted a literature review of peer-reviewed articles, systematic reviews, pilot, and case-control studies. Searches were performed using PubMed and Scopus. Search criteria included keyword phrases such as "hidradenitis suppurativa", "nutrition in hidradenitis suppurativa", "Western Diet and HS", "brewer’s yeast", "leucine and progression of HS", and "Mediterranean diet benefits for HS". Publications from 1998 and 2024 were reviewed, and a final selection of 26 peer-reviewed works were synthesized.
RESULTS
This review included 26 peer-reviewed works published between 1998 and 2024. Many works discussed the pathophysiology behind diet and HS, while others reported on studies conducted to investigate specific dietary modifications' effects on HS. This article intends to expand on some of the major themes seen across the reported literature: diets that exacerbate HS, beneficial diets to help mitigate HS flares, mineral/vitamin supplement recommendations for HS patients, and fasting practices.
The "Western diet" has been identified in the exacerbation of HS. A dietary pattern rich in meat, glucose, fat, and leucine, the western diet includes many pro-inflammatory foods rich in saturated and trans fats. These leucine-rich foods also increase mTOR activity, which contributes to lipogenesis in sebaceous glands. Leucine activates RagGTPases, which activate mTOR to produce SREBP, a master transcription factor of lipogenesis.2 Diets rich in dairy products are also implicated in exacerbating HS. Casein, a primary protein found in dairy products, elevates IGF1, which enhances androgen receptor activity. The open androgen receptor becomes vulnerable to endogenous and exogenous androgens from multiple sources (adrenals, ovaries, testes, hormones, and anabolic steroids). These androgens synergize to mediate the plugging and further rupture of the
The "Western diet" has been identified in the exacerbation of HS. A dietary pattern rich in meat, glucose, fat, and leucine, the western diet includes many pro-inflammatory foods rich in saturated and trans fats. These leucine-rich foods also increase mTOR activity, which contributes to lipogenesis in sebaceous glands. Leucine activates RagGTPases, which activate mTOR to produce SREBP, a master transcription factor of lipogenesis.2 Diets rich in dairy products are also implicated in exacerbating HS. Casein, a primary protein found in dairy products, elevates IGF1, which enhances androgen receptor activity. The open androgen receptor becomes vulnerable to endogenous and exogenous androgens from multiple sources (adrenals, ovaries, testes, hormones, and anabolic steroids). These androgens synergize to mediate the plugging and further rupture of the
