Abstract
Background
Hidradenitis suppurativa affects up to 4% of the population worldwide. Many treatment options exist but these come with a significant side-effect profile. Exercise, weight loss, and dietary modifications may be simple inexpensive alternatives and/or adjuncts to treating this disease.
Objectives
We aimed to summarize published evidence on the effects of dietary, weight loss, and exercise interventions on the clinical course, severity, or subjective improvement of hidradenitis suppurativa and to provide a framework regarding dietary changes and exercise modalities for clinicians treating this disease.
Methods
A literature search of Scopus (1993 onwards), PubMed (1986 onwards), and MEDLINE (OVID interface, 1946 onwards) was conducted on 22 October, 2022. Case–control studies, cohort studies, and randomized controlled trials with five or more subjects conducted on adult participants (aged >18 years) were included; case reports, case series, and review papers were excluded.
Results
Fifteen studies involving 2829 patients were included, encompassing nine cohort studies, five cross-sectional studies, and one cross-over study. Patients who were female, lost more than 50 pounds (22.7 kg), or were obese prior to weight loss saw improvement in hidradenitis suppurativa severity with weight loss. There was evidence for beneficial effects of diets, such as the Mediterranean diet that minimizes sugar, highly processed carbohydrates, and dairy, and emphasizes chicken, fruits, and vegetables, in patients with hidradenitis suppurativa. Evidence also supported benefit from oral zinc and vitamin D supplementation.
Conclusions
More evidence is needed in the form of randomized controlled trials or well-designed controlled trials to evaluate the effect of exercise and dietary manipulation on the hidradenitis suppurativa disease course. Overall, there is significant but weak evidence to support improvement in hidradenitis suppurativa severity with weight loss, dietary changes, and micronutrient supplementation. There is no significant evidence to support improvement in hidradenitis suppurativa symptomology with any type of exercise intervention.
Clinical Trial Registration
This protocol was registered with PROSPERO with the registration number CRD4202235099.
Similar content being viewed by others
References
Sellheyer K, Krahl D. “Hidradenitis suppurativa” is acne inversa! An appeal to (finally) abandon a misnomer. Int J Dermatol. 2005;44(7):535–40. https://doi.org/10.1111/j.1365-4632.2004.02536.x.
Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 2020;82(5):1045–58. https://doi.org/10.1016/j.jaad.2019.08.090.
Khan A, Chang MW. The role of nutrition in acne vulgaris and hidradenitis suppurativa. Clin Dermatol. 2022;40(2):114–21. https://doi.org/10.1016/j.clindermatol.2022.04.001.
Kurayev A, Ashkar H, Saraiya A, Gottlieb AB. Hidradenitis suppurativa: review of the pathogenesis and treatment. J Drugs Dermatol. 2016;15(8):1017–22.
OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653. Accessed 19 Jan 2023.
Higgins J, James T. Table 8.5.a: the Cochrane Collaboration’s tool for assessing risk of bias. In: Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions. Hoboken (NJ): Wiley-Blackwell; 2020.
Kromann CB, Ibler KS, Kristiansen VB, Jemec GB. The influence of body weight on the prevalence and severity of hidradenitis suppurativa. Acta Derm Venereol. 2014;94(5):553–7. https://doi.org/10.2340/00015555-1800.
Sartorius K, Emtestam L, Jemec GBE, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol. 2009;161:831–9.
Macklis PC, Tyler K, Kaffenberger J, Kwatra S, Kaffenberger BH. Lifestyle modifications associated with symptom improvement in hidradenitis suppurativa patients. Arch Dermatol Res. 2021. https://doi.org/10.1007/s00403-021-02233-y.
Kjaersgaard Andersen R, Loft IC, Hansen T, Hjalgrim H, Rostgaard K, Banasik K, et al. Incidence and remission rates of self-reported hidradenitis suppurativa: a prospective cohort study conducted in Danish blood donors. J Eur Acad Dermatol Venereol. 2021. https://doi.org/10.1111/jdv.17857.
Garcovich S, De Simone C, Giovanardi G, Robustelli E, Marzano AV, Peris K. Post-bariatric surgery hidradenitis suppurativa: a new patient subset associated with malabsorption and micronutritional deficiencies. Clin Exp Dermatol. 2019;44(3):283–9. https://doi.org/10.1111/ced.13732.
Dempsey A, Butt M, Kirby JS. Prevalence and impact of dietary avoidance among individuals with hidradenitis suppurativa. Dermatology. 2020;236(4):289–95. https://doi.org/10.1159/000503063.
Fernandez JM, Marr KD, Hendricks AJ, Price KN, Ludwig CM, Maarouf M, et al. Alleviating and exacerbating foods in hidradenitis suppurativa. Dermatol Ther. 2020;33(6): e14246. https://doi.org/10.1111/dth.14246.
Kurzen H, Kurzen M. Secondary prevention of hidradenitis suppurativa. Dermatol Rep. 2019;11(2):8243. https://doi.org/10.4081/dr.2019.8243.
Lorite-Fuentes I, Montero-Vilchez T, Arias-Santiago S, Molina-Leyva A. Potential benefits of the Mediterranean diet and physical activity in patients with hidradenitis suppurativa: a cross-sectional study in a Spanish population. Nutrients. 2022;14(3):551. https://doi.org/10.3390/nu14030551.
Barrea L, Fabbrocini G, Annunziata G, et al. Role of nutrition and adherence to the Mediterranean diet in the multidisciplinary approach of hidradenitis suppurativa: evaluation of nutritional status and its association with severity of disease. Nutrients. 2018;11(1):57. https://doi.org/10.3390/nu11010057.
Harvard Health. Foods that fight inflammation. 2021. https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation. Accessed 18 Jan 2022.
Bragazzi NL, Sellami M, Salem I, Conic R, Kimak M, Pigatto PDM, et al. Fasting and its impact on skin anatomy, physiology, and physiopathology: a comprehensive review of the literature. Nutrients. 2019;11:249.
Damiani G, Mahroum N, Pigatto PDM, Pacifico A, Malagoli P, Tiodorovic D, et al. 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. Nutrients. 2019;11(8):1781. https://doi.org/10.3390/nu11081781.
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;154(5):1126–30. https://doi.org/10.1016/j.surg.2013.04.018.
Zholudev A, Zurakowski D, Young W, Leichtner A, Bousvaros A. Serologic testing with ANCA, ASCA, and anti-OmpC in children and young adults with Crohn’s disease and ulcerative colitis: diagnostic value and correlation with disease phenotype. Am J Gastroenterol. 2004;99(11):2235–41. https://doi.org/10.1111/j.1572-0241.2004.40369.x.
Aboud C, Zamaria N, Cannistrà C. Treatment of hidradenitis suppurativa: surgery and yeast (Saccharomyces cerevisiae)-exclusion diet: results after 6 years. Surgery. 2020;167(6):1012–5. https://doi.org/10.1016/j.surg.2019.12.015.
Brocard A, Knol AC, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach: a pilot study. Dermatology. 2007;214(4):325–7. https://doi.org/10.1159/000100883.
Molinelli E, Brisigotti V, Campanati A, Sapigni C, Giacchetti A, Cota C, et al. Efficacy of oral zinc and nicotinamide as maintenance therapy for mild/moderate hidradenitis suppurativa: a controlled retrospective clinical study. J Am Acad Dermatol. 2020;83(2):665–7. https://doi.org/10.1016/j.jaad.2020.04.092.
Fabbrocini G, Marasca C, Luciano MA, Guarino M, Poggi S, Fontanella G, et al. Vitamin D deficiency and hidradenitis suppurativa: the impact on clinical severity and therapeutic responsivity. J Dermatolog Treat. 2021;32(7):843–4. https://doi.org/10.1080/09546634.2020.1714538.
Yeh C, Flatley E, Elkattawy O, Berger L, Rao B. Exercise in dermatology: exercise’s influence on skin aging, skin cancer, psoriasis, venous ulcers, and androgenetic alopecia. J Am Acad Dermatol. 2021. https://doi.org/10.1016/j.jaad.2021.07.023.
Danby FW. Turning acne on/off via mTORC1. Exp Dermatol. 2013;22:505–6.
Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol. 2015;73(5 Suppl. 1):S52–4. https://doi.org/10.1016/j.jaad.2015.07.042.
Seetan K, Eldos B, Saraireh M, et al. Prevalence of low vitamin D levels in patients with Hidradenitis suppurativa in Jordan: a comparative cross-sectional study. PLoS ONE. 2022;17(3): e0265672. https://doi.org/10.1371/journal.pone.0265672.
Kelly G, Sweeney CM, Fitzgerald R, et al. Vitamin D status in hidradenitis suppurativa. Br J Dermatol. 2014;170(6):1379–80. https://doi.org/10.1111/bjd.12900.
Van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol. 2005;97(1–2):93–101. https://doi.org/10.1016/j.jsbmb.2005.06.002.
Dreno B, Trossaert M, Boiteau HL, Litoux P. Zinc salts effects on granulocyte zinc concentration and chemotaxis in acne patients. Acta Derm Venereol. 1992;72:250–2.
Sainte Marie I, Jumbou O, Tenaud I, Dréno B. Comparative study of the in vitro inflammatory activity of three nickels salts on keratinocytes. Acta Derm Venereol. 1998;78:169–72.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No sources of funding were received for the preparation of this article.
Conflicts of interest/competing interests
Isaac Weber, Josie Giefer, and Kari L. Martin have no conflicts of interest that are directly relevant to the content of this article.
Ethics approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Availability of data and material
The data that support the findings of this study are available from Isaac Weber upon reasonable request.
Code availability
Not applicable,
Author contributions
IW conceived the presented idea, synthesized the data, and wrote the preliminary manuscript. JG and KM verified the search terms and methods. IW and JG screened and assessed all studies for eligibility. All authors discussed the results and contributed to the final manuscript.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Weber, I., Giefer, J. & Martin, K.L. Effects of Exercise and Dietary Modifications on Hidradenitis Suppurativa: A Systematic Review. Am J Clin Dermatol 24, 343–357 (2023). https://doi.org/10.1007/s40257-023-00756-w
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40257-023-00756-w