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Lifestyle modifications associated with symptom improvement in hidradenitis suppurativa patients

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that substantially reduces patient quality of life. Many HS patients ask their dermatologist about potential lifestyle modifications, such as following particular diets or avoiding specific products, in an attempt to alleviate their symptoms. However, insufficient research has been conducted to support well-informed lifestyle modification counseling, and patients frequently defer to anecdotal endorsements of various interventions found on social media support groups. Therefore, we sought to clarify what lifestyle modifications were capable of improving HS symptoms.

Methods

We conducted a survey-based study to examine modifiable risk factors and their association with the severity of HS. Five hundred and ninety-one patients with HS participated in an online survey detailing the severity of their HS symptoms before and after various lifestyle interventions. Average improvements in both subjective and objective ratings of symptom severity were calculated and statistical differences between the levels of improvement seen among various categories of lifestyle interventions were determined.

Results

Numerous lifestyle interventions including substantial weight loss, smoking cessation, use of gentle skin and depilatory products, and menstrual regulation were associated with both subjective and objective improvements in symptom severity.

Conclusions

Our results suggest that patients affected by HS may experience clinically significant improvement from a variety of lifestyle modifications.

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References

  1. Cosmatos I, Matcho A, Weinstein R, Montgomery MO, Stang P (2013) Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States. J Am Acad Dermatol 68(3):412–419

    Article  Google Scholar 

  2. Ofenloch RF (2017) Health-related quality of life in hidradenitis suppurativa. Br J Dermatol 176(4):861–862

    CAS  Article  Google Scholar 

  3. Danby FW (2015) Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol 73(5 Suppl 1):S52-54

    Article  Google Scholar 

  4. Ingram JR, Collier F, Brown D, Burton T, Burton J, Chin MF et al (2019) British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol 180(5):1009–1017

    CAS  Article  Google Scholar 

  5. Eiken HC, Holm JG, Thomsen SF (2020) Studies on the role of diet in the management of hidradenitis suppurativa are needed. J Am Acad Dermatol 82(4):e137–e138

    Article  Google Scholar 

  6. Dempsey A, Butt M, Kirby JS (2020) Prevalence and Impact of Dietary Avoidance among Individuals with hidradenitis suppurativa. DRM 236(4):289–295

    Google Scholar 

  7. von der Werth JM, Williams HC (2000) The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 14(5):389–392

    Article  Google Scholar 

  8. Alikhan A, Lynch PJ, Eisen DB (2009) Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 60(4):539–561

    Article  Google Scholar 

  9. Revuz JE, Canoui-Poitrine F, Wolkenstein P, Viallette C, Gabison G, Pouget F et al (2008) Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol 59(4):596–601

    Article  Google Scholar 

  10. Sartorius K, Emtestam L, Jemec GBE, Lapins J (2009) Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol 161(4):831–839

    CAS  Article  Google Scholar 

  11. Joseph MA, Jayaseelan E, Ganapathi B, Stephen J (2005) Hidradenitis suppurativa treated with finasteride. J Dermatolog Treat 16(2):75–78

    CAS  Article  Google Scholar 

  12. Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD (2013) Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County. Minnesota J Invest Dermatol 133(1):97–103

    CAS  Article  Google Scholar 

  13. Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F et al (2009) Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol 61(1):51–57

    Article  Google Scholar 

  14. Crowley J, Mekkes J, Zouboulis C, Scheinfeld N, Kimball A, Sundaram M et al (2014) Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities. Br J Dermatol 171(6):1561–1565

    CAS  Article  Google Scholar 

  15. Schrader AMR, Deckers IE, van der Zee HH, Boer J, Prens EP (2014) Hidradenitis suppurativa: a retrospective study of 846 Dutch patients to identify factors associated with disease severity. J Am Acad Dermatol 71(3):460–467

    Article  Google Scholar 

  16. Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD (2015) Hidradenitis suppurativa and metabolic syndrome: a comparative cross-sectional study of 3207 patients. Br J Dermatol 173(2):464–470

    CAS  Article  Google Scholar 

  17. Bettoli V, Naldi L, Cazzaniga S, Zauli S, Atzori L, Borghi A et al (2016) Overweight, diabetes and disease duration influence clinical severity in hidradenitis suppurativa-acne inversa: evidence from the national Italian registry. Br J Dermatol 174(1):195–197

    CAS  Article  Google Scholar 

  18. Egeberg A, Gislason GH, Hansen PR (2016) Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol 152(4):429–434

    Article  Google Scholar 

  19. Vossen ARJV, van Straalen KR, Prens EP, van der Zee HH (2017) Menses and pregnancy affect symptoms in hidradenitis suppurativa: a cross-sectional study. J Am Acad Dermatol 76(1):155–156

    Article  Google Scholar 

  20. Barth JH, Layton AM, Cunliffe WJ (1996) Endocrine factors in pre- and postmenopausal women with hidradenitis suppurativa. Br J Dermatol 134(6):1057–1059

    CAS  Article  Google Scholar 

  21. r/Hidradenitis (2020). reddit. https://www.reddit.com/r/Hidradenitis/. Accessed 7 Aug 2020

  22. HSSA - Hidradenitis Suppurativa Symptom Assessment (2020). https://eprovide.mapi-trust.org/instruments/hidradenitis-suppurativa-symptom-assessment. Accessed 29 Apr 2020

  23. Senthilnathan A, Kolli SS, Cardwell LA, Richardson I, Feldman SR, Pichardo RO (2019) Validation of a hidradenitis suppurativa self-assessment tool. J Cutan Med Surg 23(4):388–390

    Article  Google Scholar 

  24. Cole DW, Fotouhi A, Fakhoury J, Daveluy S (2019) An internet-based survey study of hidradenitis suppurativa patients: use of the internet for disease-related information. J Am Acad Dermatol. https://doi.org/10.1016/j.jaad.2019.12.024

    Article  PubMed  Google Scholar 

  25. Tavora IG, Bissoli GC, Miot HA, Schmitt JV (2019) Clinical manifestations and quality of life in hidradenitis suppurativa patients: survey of participants from an internet support group. An Bras Dermatol 94(3):298–303

    Article  Google Scholar 

  26. Paleo diet: Eat like a cave man and lose weight? (2020). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/paleo-diet/art-20111182. Acccessed 31 Jul 2020

  27. Anti-Inflammatory Diet: Road to Good Health? (2020). WebMD. https://www.webmd.com/diet/anti-inflammatory-diet-road-to-good-health. Accessed 31 Jul 2020

  28. Macklis P, Adams KM, Li D, Krispinsky A, Bechtel M, Trinidad J, et al. (2019) The impacts of oral health symptoms, hygiene, and diet on the development and severity of psoriasis. Dermatol Online J. 25(7):1–5

  29. Prens E, Deckers I (2015) Pathophysiology of hidradenitis suppurativa: an update. J Am Acad Dermatol 73(5):S8-11

    CAS  Article  Google Scholar 

  30. David Boothe W, Tarbox JA, Tarbox MB (2017) Atopic dermatitis: pathophysiology. Adv Exp Med Biol 1027:21–37

    CAS  Article  Google Scholar 

  31. American College of Physicians (2003) Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States. Ann Intern Med 138(11):891

    Article  Google Scholar 

  32. Hidradenitis suppurativa: Management-UpToDate (2020). https://www.uptodate.com/contents/hidradenitis-suppurativa-management?search=hidradenitis%20suppurativa&source=search_result&selectedTitle=1~66&usage_type=default&display_rank=1. Accessed 2020 1 Aug

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Correspondence to Benjamin H. Kaffenberger.

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Macklis, P.C., Tyler, K., Kaffenberger, J. et al. Lifestyle modifications associated with symptom improvement in hidradenitis suppurativa patients. Arch Dermatol Res 314, 293–300 (2022). https://doi.org/10.1007/s00403-021-02233-y

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  • DOI: https://doi.org/10.1007/s00403-021-02233-y

Keywords

  • Dermatology
  • Diet
  • Inflammation
  • Hidradenitis suppurativa