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

Damiani Damiani,Tiodorovic Tiodorovic,Adawi Adawi,Mahroum Mahroum,Pacifico Pacifico,Pigatto Pigatto,Conic Conic,Watad Watad,Malagoli Malagoli,Bragazzi Bragazzi,Amital Amital

doi:10.3390/nu11081781

Abstract

Hidradenitis suppurativa (HS) is a chronic-relapsing and debilitating disease, which affects the components of the folliculopilosebaceous unit and severely impacts on the perceived health-related quality of life. Among the possible treatments, dietary interventions, such as fasting, have been described to positively impact on HS. However, nothing is known about the effects of circadian, intermittent fasting, such as the Ramadan fasting. A sample of 55 HS patients (24 males (43.6%) and 31 females (56.4%), mean age 39.65 ± 8.39 years, average disease duration 14.31 ± 7.03 years) was recruited in the present study. The “Severity of International Hidradenitis Suppurativa Severity Score System” (IHS4) decreased significantly from 11.00 ± 5.88 (before Ramadan) to 10.15 ± 6.45 (after Ramadan), with a mean difference of −0.85 ± 0.83 (p < 0.0001). At the univariate analyses, the improvement was associated with HS phenotype (with a prominent improvement among those with ectopic type), treatment (with the improvement being higher in patients receiving topical and systemic antibiotics compared to those treated with biologics), the “Autoinflammatory Disease Damage Index” (ADDI), and Hurley scores. At the multivariate regression analysis, only the Hurley score (regression coefficient = 0.70, p = 0.0003) was found to be an independent predictor of change in the IHS4 score after fasting. The improvement in the IHS4 score was not, however, associated with weight loss. In conclusion, the Ramadan fasting proved to be safe and effective in HS patients. Considering the small sample size and the exploratory nature of the present investigation, further studies in the field are warranted, especially longitudinal, prospective and randomized ones.

Highlights

Hidradenitis suppurativa (HS), known as acne inversa or Verneuil’s disease, is a chronic, debilitating condition, affecting the components of the folliculopilosebaceous unit and surrounding tissue, such as hair follicles and apocrine sweat glands [1,2]
The present multi-center, observational, cross-over, pilot, exploratory study demonstrated that in HS patients, observing an intermittent fasting during the month of Ramadan has led to a significant improvement in the IHS4 score
This improvement was found to be associated with the HS phenotype, treatment received, and the Autoinflammatory Disease Damage Index” (ADDI) and Hurley scores, but not with a change in weight

Summary

Introduction

Hidradenitis suppurativa (HS), known as acne inversa or Verneuil’s disease, is a chronic, debilitating condition, affecting the components of the folliculopilosebaceous unit and surrounding tissue, such as hair follicles and apocrine sweat glands [1,2]. HS is clinically characterized by recurrent, relapsing episodes of swollen, deep-seated, and rather painful abscesses and nodules, hypertrophic scars, draining fistulae and sinus tracts. These generally involve the skin folds and other body areas, like axillary, inguinal, anogenital, and infra-mammary areas, where contacts, pressures, shearing forces, and frictions are frequent [2,3,4]. HS is a systemic, autoinflammatory condition [5] since several disorders, including autoimmune/autoinflammatory conditions, have been shown to be associated with HS, like inflammatory bowel disease (IBD) and spondyloarthropathies [6], non-alcoholic fatty liver disease (NAFLD) [7] or neutrophilic interstitial pneumonia [8], among others

Methods

Results

Discussion

Conclusion