If you have hidradenitis suppurativa (HS), a chronic skin condition that causes painful lumps and scarring, anything that can help your symptoms — even a little bit — can come as a relief.
Dietary changes can help control inflammation and minimize flares in some patients, says So Yeon Paek, MD, FAAD, an assistant clinical professor at Texas A&M College of Medicine, faculty member at Baylor University Medical Center in Dallas, and physician at Dermatology Physicians of Dallas.
“It is certainly far from a cure for the disease but may help to reduce flares and, in milder disease — what we call Hurley stage 1 or 2 disease — can actually lead to significant improvement,” she says.
There is no standard diet for HS, and much more research is needed to determine what works best and for whom. Trial and error is often involved in determining an optimal eating pattern. In general, though, a healthy, nutritious diet low in processed foods can help reduce inflammation, an important component of HS management. You may also find relief if you eliminate specific foods from your diet.
“Weight and obesity play a big role in HS, and there is good evidence to suggest that weight loss — even losing about 15 percent of body weight — can lead to an improvement of HS,” says Dr. Paek. If you’re overweight or obese, weight loss can help reduce friction in the skin folds where HS occurs and your inflammation overall, she says.
Discuss the following ideas with your doctor to see if any might be a fit for you.
1. Do Keep a Food Diary to See Which Foods May Affect Your Symptoms
By writing down what you eat and noting the severity of your symptoms, you can glean important clues about which foods may cause flares or make them worse. Since not everyone has the same trigger foods, it’s helpful to develop a personalized log and show it to your doctor at your next visit. “You don’t want to just restrict nutritional intake without consulting a physician,” says Paek. “There might be risks to doing that, and it’s a very individual situation, so I think it’s good to show that to a healthcare provider. You can discuss the potential role for certain foods, talk about any data or evidence in the literature to suggest a connection, and then go from there.”
Your doctor might recommend an elimination diet, where you completely cut one food or food group from your diet at a time so you can see how each affects you, says Paek. Be patient, because these diets don’t work instantly. It can take weeks — or even months — to see improvement.
2. Don’t Forget About Fiber
Fiber is important for everyone, and people with HS are certainly no exception. “It’s not particularly specific to HS, but fiber can increase your feeling of fullness or satiety,” says Paek. “[This] can help reduce your intake of unhealthy foods, which then may actually lead to weight loss.” Also, high-fiber foods tend to help reduce blood sugar and improve healthy gut function, which can help keep inflammation at bay. According to the Dietary Guidelines for Americans, 2020–2025, issued by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, adults need 22 to 34 grams of fiber per day, depending on age and sex.
3. Do Ask Your Doctor About Eliminating Dairy
Dairy foods contain proteins and hormones that have been linked to inflammation in follicular ducts below the surface of the skin and increased sebum, or oil, production, says Paek. Some patients notice an improvement in their symptoms within weeks of eliminating dairy.
4. Don’t Eat Too Many Added Sugars or Refined Carbs
In a study published in August 2020 in the journal Dermatologic Therapy, HS patients listed the foods that most commonly exacerbated symptoms. First on the list were sweets, followed by bread, pasta, and rice. Added sugars and highly refined simple carbohydrates break down into sugar, which can increase blood sugar and spike insulin. This can promote inflammation, blockages of the follicular ducts, and HS flares, says Paek.
The Dietary Guidelines for Americans recommends consuming less than 10 percent of your calories from added sugars and less than three ounces of refined grains per day. Bonus: Reducing intake of these foods has been linked to many health benefits beyond HS.
5. Do Consider Eliminating Foods That Contain Brewer’s Yeast
Brewer’s yeast (Saccharomyces cerevisiae) is a common ingredient in baked goods and fermented foods, such as cheese, soy sauce, and alcohol. Some people make antibodies against this yeast, a phenomenon linked to some autoimmune diseases. In a study published in June 2020 in the journal Surgery, 70 percent of people with HS who eliminated brewer’s yeast from their diets showed an improvement in HS symptoms, perhaps due to a reduction in inflammation.
6. Don’t Skip Foods Rich in Omega-3 Fatty Acids
Omega-3 fatty acids, found in high amounts in fatty fish, such as salmon and tuna, are an important component of a healthy diet, thanks to their anti-inflammatory properties. The American Heart Association recommends eating two servings of fatty fish per week. There are no specific studies looking at omega-3 intake in people with HS, but in theory, the inflammation-reducing powers of these fats could help, says Paek.
7. Do Consider Cutting Back on Nightshades
Some people with HS find relief when they cut out foods in the nightshade family, such as potatoes, tomatoes, eggplant, and peppers. The theory is that these foods may increase gut permeability and lead to a leaky gut, which can put your body in a more inflammatory state, says Paek.
While more patients benefit from a diet free of brewer’s yeast than one free of nightshades, this one could be worth a try, because it’s easier, says Paek. You can substitute with other nutritious veggies that aren’t in the nightshade family.
8. Don’t Take Supplements Without First Talking to Your Doctor
Supplements may help some people with HS, but as with food changes, it’s important to talk to your doctor before taking any. Some people with mild to moderate HS benefit from a zinc supplement, which can boost immune system activity, says Paek. It can also contribute to nausea and diarrhea in some people, though, and zinc may react with medications such as blood pressure drugs and antibiotics. If you take a supplement with zinc, you may also have to supplement with copper, because zinc supplementation can lead to a copper deficiency.
Then there’s vitamin D. Some research has suggested that people with more severe HS tend to have lower vitamin D levels than those with milder cases of the disease. It’s unclear whether supplementation is beneficial, but if you are truly deficient in vitamin D — something your doctor can measure with a blood test — it may be recommended. One small study also suggested that vitamin B12 supplementation could be beneficial in people with HS.
9. Do Ask Your Doctor or Dietitian if a Specific Diet May Help
The famous Mediterranean diet, rich in olive oil, fish, fruits, vegetables, and whole grains, could be a good choice. “I think that is probably one of the first diets I would recommend to patients if they were to consider a complete dietary change versus specific food elimination,” says Paek. A study published in December 2018 in the journal Nutrients found that people who followed a Mediterranean diet had less severe HS than others. This diet is rich in antioxidants and other nutrients that may help reduce inflammation.
Another diet to ask about is the Paleo diet, which is often recommended for other immune disorders, such as Crohn’s disease. There’s some overlap between HS and Crohn’s: People with HS have a higher risk of Crohn’s than those without HS, suggests a review published in July 2019 in JAMA Dermatology. “Something that is beneficial for this other immune-mediated condition, Crohn’s, may also be beneficial for HS, so I do have patients who have both conditions and have tried this specific diet,” says Paek. “In popular terms it’s a Paleo diet, but it’s very similar to what a Crohn’s-specific diet is: nut free, gluten free, grain free, legume free, nightshade free.”
You could also ask about a keto diet, which is low in carbs and high in fat. While there’s no specific research linking it to HS, it could be beneficial if it helps you reduce excess weight. Another possibility is the autoimmune protocol diet, which is similar to Paleo and designed for autoimmune conditions and inflammation reduction.
“It’s critical to work with a healthcare provider to make sure that you’re not engaging in a dietary change that may negatively affect health overall,” says Paek. “Some patients need to take in certain food groups for various reasons, and we don’t want to compromise overall health by engaging in certain diets.”
The bottom line? “The focus should be on common things: Reduce consumption of high-sugar foods, focus on healthier eating choices, consider eliminating certain specific foods, and then supplement if there is a known deficiency, such as vitamin D,” says Paek.
It’s also important to remember that dietary changes may not necessarily help everyone. “That’s why the recommendations are not universal,” says Paek. “They’re just recommendations, not guidelines for care.” Think of dietary modification as just one part of your overall HS management strategy and healthy lifestyle.