Applications of Lifestyle Medicine in the Management of Hidradenitis Suppurativa: A Literature Review

Abstract

Introduction: Hidradenitis Suppurativa (HS) is an inflammatory skin condition characterized by the formation of pus-discharging abscesses under the skin in axillary, inguinal, gluteal, and perianal body sites. Modifiable risk factors such as obesity and smoking have been associated with exacerbation of HS severity. Despite this, research on the clinical application of lifestyle medicine for the improvement of HS symptoms remains scarce. The goal of this review was to evaluate benefits of lifestyle medicine in improving HS symptoms. Methods: A total of 8 articles that examined the associations of smoking cessation, diet modification and weight-loss with HS improvement were investigated. These publications came from cohort studies and intervention trials and were appraised using the Critical Appraisal Skills Programme checklist. Results: HS patients following a brewer’s yeast free diet reported significant decrease in HS abscesses and a severe immune reaction to the substance. The Paleolithic and Anti-Inflammatory diet alongside the reduction of foods high in carbohydrates, sugars, and dairy were also associated with improved HS symptoms. Zinc gluconate supplementation demonstrated improved inflammatory nodules and decreased boil count in patients. No correlation between HS and weight-loss or smoking cessation were observed. Discussion: Based on the results, eating patterns resembling the Paleolithic and Anti-Inflammatory diets may lower levels of systemic inflammation in HS patients by reducing the production of TNF- α cytokines present in HS lesions. Increased levels of antioxidants paired with fewer levels of pro-oxidant properties present in both diets are suggested to help improve the course of the disease in some patients. Conclusion: Further intervention trials and cohort studies must be conducted investigating the effects of smoking cessation, weight-loss and diet in HS severity to determine the integration of lifestyle medicine pillars in clinical practice. No correlations between smoking cessation and weight-loss with HS were established due to limited clinical evidence. Intervention trials beyond exclusionary diets need to be conducted to elucidate the role of nutrition in HS exacerbation and alleviation.