Hidradenitis Suppurativa, Diet, And PCOS

Women with PCOS sure have their share of dermatological concerns. These include acne, excess body hair growth, and hair loss or alopecia. But there is another lesser known PCOS-related symptom that some women with the condition experience called Hidradenitis Suppurativa (HS). Often referred to as “bumps” or “boils,” HS can have a significant impact on a woman’s self-esteem and body image. Recent research is showing advancements in treatment options for HS, including nutrition modifications. Here’s what you need to know.

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is a chronic inflammatory skin condition in both men and women resulting in pea-sized or larger lumps above and beneath the skin. The lumps tend to develop around hair follicles in places where the skin rubs together such as under the arms, thighs, groin, under breasts, and between buttocks. These unsightly lumps can be painful and even break open, releasing a foul-smelling pus.

The lumps usually start around puberty and can worsen over time. Lumps can be connected by tunnels under the skin and spread to other areas. Lumps can become reddened and inflamed and are slow to heal. One nutrition coaching patient of mine found a lump in her breast only to have it biopsied to reveal it was HS and not a tumor.

PCOS and Hidradenitis Suppurativa

An association between HS and diabetes, hyperlipidemia, obesity, hypertension, and metabolic syndrome among patients with HS has been found (1).

HS is believed to be an autoimmune condition. HS in women with PCOS is associated with excess testosterone and other androgens. Excessive weight, heat, sweating, smoking, eating an unhealthy diet, and stress can worsen HS.

The emotional toll of HS can be severe. Women who suffer from HS may feel embarrassed and frustrated about the unsightly lumps, affecting their body image and mood, leading to depression.

Treatment for Hidradenitis Suppurativa

Overall, HS is not well understood. The literature is limited and there is a shortage of randomized, controlled trials. Traditional treatment of HS have primarily focused on the use of antibiotics, laser treatments, and surgery. However, these forms of treatment only provide temporary relief as most women see a relapse in symptoms.

Now a variety of treatments used together is believed to be an effective way to treat and prevent HS flare ups from occurring. Treatment may be focused at targeting several aspects of HS including decreasing the bacterial load and the immune response, altering the hormonal balance, and improving wound healing (3).

Now that a hormone imbalance of higher androgens has been linked to HS, more emphasis has been placed at finding effective antiandrogen treatments. A study in the Journal of Cutaneous Medicine and Surgery found that antiandrogen therapy was superior to oral antibiotic therapy (55% vs 26%) in treating HS (2).

While not approved for treatment in PCOS, Spironoloactone, a weak anti-hypertensive medication, is a popular antiandrogen for this population. Metformin use may also be effective. One study found metformin improved symptoms and quality of life in patients with HS unresponsive to other treatments. Metformin also has antiandrogen properties.

High levels of insulin are correlated with higher androgens among women with PCOS; lowering insulin levels can reduce androgen levels. Androgens (and insulin) can be lowered with diet, exercise, and weight loss. Weight loss has shown to be improve HS as well (4).

Diet and Hidradenitis Suppurativa

Research examining the link between HS and diet is lacking. One study involving 12 people with HS found that avoidance of wheat and brewer’s yeast for 12 months, showed an immediate reduction and stabilized symptoms in HS symptoms. An immediate recurrence of skin lesions occurred following accidental or voluntary consumption of beer or other foods containing brewer’s yeast or wheat (5).

While there is no science-based evidence to support it, the paleo diet which involves eliminating grains, beans, and dairy, is widely promoted as the cure for HS on the internet. In her book entitled “The Hidden Plague: A Field Guide for Surviving and Overcoming Hidradenitis Suppurativa ” Tara Grant, a woman suffering from HS and PCOS, details her 20-year experience with it and how she overcame the disease by eating a paleo type diet (6).

The strongest research is supported by a study published in Clinical Obstetrics and Gynecology, suggested that HS symptoms improve with a dairy free and low glycemic-load diet (7).

Since HS is an inflammatory condition, following an anti-inflammatory diet may play a role in treating HS. Following a FODMAPs diet by eliminating hard to digest “trigger” foods which cause inflammation may be effective.

Emerging research is showing that zinc can help with HS as well. Patients who took zinc gluconate, 90mg/day along with a topical medicine showed significant reductions in the appearance of boils after 3 months of treatment.

In addition, these diet strategies may help to reduce inflammation in HS:

  • Avoid sugar, white flour, and wheat
  • Avoid refined or processed high glycemic index foods
  • Consume a diet rich in colorful fruits and vegetables
  • Eat cold water or fatty fish like salmon, tuna, or trout at least twice a week
  • Include plenty of unsaturated fats into your diet like avocado, olive oil, nuts, and seeds

Do you suffer from HS? What has helped you?

Sources
1. Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD. Hidradenitis Suppurativa and the Metabolic Syndrome A Comparative Cross-sectional Study of 3,207 Patients. Br J Dermatol. 2015 Mar 11.

2.Kraft JN, Searles GE. Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy. J Cutan Med Surg. 2007 Jul-Aug;11(4):125-31.

3.Gill L1, Williams M2, Hamzavi I2.Update on hidradenitis suppurativa: connecting the tracts. Prime Rep. 2014 Dec 1;6:112.

4.Boer J. Resolution of hidradenitis suppurativa after weight loss by dietary measures, especially on frictional locations. J Eur Acad Dermatol Venereol. 2015 Mar 2.

5.Cannistrà C, Finocchi V, Trivisonno A, Tambasco D. New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer’s yeast-exclusion diet. Surgery. 2013 Nov;154(5):1126-30.

6.Grant T: The Hidden Plague: A Field Guide For Surviving and Overcoming Hidradenitis Suppurativa. New York: Primal Nutrition; 2013.

7. Danby FW1. Diet in the prevention of hidradenitis suppurativa (acne inversa).J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S52-4.

8. Hessam S. Combination of oral zinc gluconate and topical triclosan: An anti-inflammatory treatment modality for initial hidradenitis suppurativa. J Dermatol Sci. 2016 Nov;84(2):197-202.

 

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Comments (18)
  • Andrea Nero

    May 14, 2015 at 2:08 pm

    Very interesting Angela – a former HS patient noticed reactions from pizza and beer – she combined going gluten free with the LEAP diet and had great response. Thanks for mentioning the Hidden Plague book, will check it out.

  • Kristen

    May 18, 2015 at 2:09 pm

    I have started using essential oils to help this condition. When I have a flare-up it does not last nearly as long. Now I’m trying different oils and supplements to prevent any flare-ups.

  • Yana

    October 1, 2015 at 2:10 pm

    I have been free of this for 2 years since almost eliminating night shades vegetables from my diet along with limiting eggs to one serve per fortnight. I also cut back on nuts but still include these just less…. I just went on a cruise and indulged in a few of these things a little too much and now 2 weeks later I have a couple of the cysts… After 2 years cured. I know it worked for me.

  • Tanika Mehta

    February 25, 2016 at 4:04 pm

    Don’t lose hope. I’ve had hypothyroidism and PCOS for 7 years now and Ive managed to have 2 beautiful kids and keep the weight off. Excersize and diet are key. And not being stressed! I also pop a vitamin everyday.

  • Julie Lyons

    August 17, 2016 at 12:48 pm

    Very interesting. I had HS around 10 years old, and no one was able to tell me what it was or what was causing it. I was put on round after round of abx, nothing would help. I remember my mother telling me that my grandma would also get these weird and gross lumps, too…but of course no one knew what it was called or that it was possibly linked to PCOS.
    Although my PCOS disnosis came later in life after I’d had children and years of normal cycles, I now know why my body did/does things when hormones are whacky….and mine is almost ALWAYS diet related.

    Thanks Angela for the info! It will be very helpful, especially if my daughter starts going through these things like I did.

    Julie

  • Angela

    September 17, 2016 at 5:07 pm

    Thank you very helpful.

  • K.C

    October 26, 2016 at 1:49 pm

    I am 24 and have had HS for about 10 years. Recently I noticed that every time I ate tomatoes, I’d have a flare up. After removing tomatoes from my diet I had great results! But recently, I have had more flare ups without eating any tomatoes. I’ll give the paleo diet a shot and see if it helps out at all.

  • Tamara

    November 19, 2016 at 7:58 pm

    The book “” The Hidden Plague” has done WONDERS FOR ME!!! No gluten, knight shades, dairy…

  • Jp

    November 24, 2016 at 1:25 am

    This was a great article! I stopped consuming potatoes, alcohol, and wheat products (especially processed pastas). I also started drinking raw milk (unpasteurized milk) and so far I haven’t had any reoccurrences in 2 months. I going to take a look at the book!

  • Erin

    January 26, 2017 at 9:58 am

    Taking a turmeric supplement has made a big difference for me. I’ve only been taking it for about a month but now if I get a bump, it stays beneath the skin, is very small, and disappears in a day or two. I’m using Mederma to reduce the scars and it seems to be working.

  • Angela Grassi

    January 26, 2017 at 10:39 am

    Great to hear Erin! Tumeric is great for inflammation.

  • Georgia

    January 28, 2017 at 4:57 am

    This information has been great. I was never told there could be a link between HS and PCOS. I have been on a medical trial using the drug Humira in weekly injections for the past 5 years. It hasn’t fully gone away as I get flareups that I think are diet and alcohol related – but no where near as bad. It is just one lump that comes up and gets a little tender and disappears. So all in all I am happy. I’d love to change my diet as well – so will look into some of these ideas.

  • Ellen

    January 31, 2017 at 10:48 am

    I am Ellen from Philippines- 29 tears old with 3 children. I was also diagnosed HS patient since 2012..until now. I was advised by a surgeon to undergo surgery,by removing the skin on my armfit and replace it with my skin to be taken from my butt area..But, i tried to consult other doctors opinion and found out that this disease has no medications..I have taken high dosage antibiotics,pain reliever but remains futile..my armfits flare up 5 times a month..But thanks God..only my miracle herbal drink can support my entire life..No flare up,No Pain; No sleepless nights and i can do everything in normal way..Now I can drive my children to school and do household activities..

  • Holly

    March 26, 2017 at 6:11 pm

    I don’t have a recommendation for prevention, but I have found that washing with sulfur soap helps to speed up the life cycle of a flare up. Cysts that used to last 7-8 days go down to 2-3 days when I wash with this. I get the soap bars from amazon and they are 10% sulfur.

  • Jennifer

    April 17, 2017 at 12:41 am

    I have Hs and pcos when I eat nightshades (potatoes,eggplant, tomatoes,bell peppers, peppers),yellow cheese, Milk/lactose, butter/margarine, wheat,pork, white,yellow, purple onions(except sweet,610,pearl onions) spices,garlic,nuts,cold cereal ,fried food, food with chemicals or food coloring any of these. no more than 2 serving of grain,legumes/beans,fruit a week. beef,gluten once in awhile
    I get flares, hard to digest,heart burn, constipation,can’t lose weight.
    when I eat 10-25 serving a day of any of these- of turkey,eggs,chicken, salmon,tuna, yogurt,Parmesan cheese,Swiss cheese, portobello mushrooms.
    2-4 serving a day veggies And root veggies, 2-4 serving a day greens or salad with 2-6 veggies
    1 serving a day or 3 a week melons, pears,grapes,kiwi,mango’s,peaches,plums,apples,cherries
    1-3 servings a day of week of healthy fats- olive oil, Avocado,coconut oil
    drink-24-32 oz a day water, 20 -40 0z mineral water once in awhile, 1- 3 cups tea,1-3 cups once in awhile herbal tea, 1 cup of coffee with coconut milk a day.
    This is what works for me

  • Jules Maher

    May 10, 2017 at 11:27 am

    At the age of 25 I was suffering with severe lesions on both breasts and under my arms, groin and between my thighs. Unfortunately I didn’t see a dermatologist in time as I had to have a bilateral breast reduction due to the amount of poison in the breasts. Nobody knew what was wrong and after unfortunately contracting MRSA and another bug called Pseudomonous I got gangrene in both breasts. Only later was I diagnosed with hidradenitis suppirativa. I don’t suffer as much under my breasts but I do on my groin area, I’m now allergic to so many antibiotics and nothing seems to help apart from hot flannels to try and draw the puss out. I’ve found that only feminine washes and powder not talcs help as they don’t clog up. I thought I would share my story, I hope that it helps yours sincerely Jules Maher

  • Canco

    November 27, 2017 at 12:20 pm

    Nightshades are the #1 trigger for me (tomatoes, potatoes, all bell peppers, and egg plant). Every HS sufferer I have talked to, nightshades are their triggers as well (most of them had allergy test done and they had nightshade allergies). I have not had an allergy test done yet but I do plan on doing one very soon.

    I have recently read studies where HS patients removed brewer’s yeast and went into complete remission. These studies are located on the internet and are a great read. It is great to see some doctors are taking an interest in HS, finally!

    I went almost 1 year without a flare up until my husband made dinner adding salsa aka tomatoes. Within 12 hours, 5 cysts appeared.

  • Jennifer

    June 5, 2019 at 8:22 pm

    White potatoes is my biggest trigger food. Followed closely by gluten and sugar

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