Potential Benefits of the Mediterranean Diet and Physical Activity in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study in a Spanish Population

Lifestyle Modifications and Nonpharmacological Treatments in Hidradenitis Suppurativa

Multimodal treatment plans are essential for effectively managing hidradenitis suppurativa (HS). To optimize patient outcomes, conventional medical and surgical treatments should be integrated with lifestyle changes and nonpharmacologic modalities. This review offers an evidence-based guide to the most studied and recommended lifestyle changes and complementary and alternative medicine (CAM) modalities for patients with HS.

Plant-Based Foods for Chronic Skin Diseases: A Focus on the Mediterranean Diet

PURPOSE OF REVIEW

In this narrative review, we provide an overview of how adherence to a Mediterranean dietary pattern can complement traditional treatment strategies for psoriasis, acne, and hidradenitis suppurativa. We emphasize the importance of an integrated approach, with dietary interventions as a key component of holistic patient care.

RECENT FINDINGS

Psoriasis, acne, and hidradenitis suppurativa are immune-mediated chronic diseases marked by systemic inflammation, with genetic and environmental factors influencing their onset. The Mediterranean diet, rich in plant-based foods with antioxidant and anti-inflammatory properties-such as whole-grain cereals, extra-virgin olive oil, vegetables, legumes, fruits, and nuts-has been shown to reduce the clinical severity of these conditions. It also supports weight control and positively impacts metabolic and cardiovascular risk factors, which are closely linked to these diseases. Dietary education, particularly about the Mediterranean diet, plays a crucial role in the management of these skin diseases and serves as an important non-pharmacological treatment option that can influence patient prognosis. This review offers specific nutrition recommendations for prescribing the Mediterranean diet to patients with chronic inflammatory skin diseases.

Obesity in Hidradenitis Suppurativa: Are GLP-1 Receptor Agonists the New Frontier?

Hidradenitis suppurativa (HS) is an inflammatory skin disorder presenting with painful and draining nodules in intertriginous areas that may progress to sinus tracts. There is an increased prevalence of obesity in HS, and obesity may predispose patients to HS. Weight loss has been associated with improvement of HS symptoms. However, weight loss through diet modification, exercise or bariatric surgery has mixed results. Recently, glucagon-like peptide-1 (GLP-1) receptor agonists have been investigated for weight loss in HS. These drugs are effective for weight loss and reduce weight-related comorbidities, with few significant side effects. Early studies of liraglutide and semaglutide in HS have demonstrated improvement in disease severity and quality of life. GLP-1 receptor agonists are a promising therapy for patients with HS and may improve symptoms through decreased mechanical stress and moderation of inflammation.

The Impact of Diet on Hidradenitis Suppurativa Severity: A Cross-Sectional Case-Control Study

Background and Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting hair follicles, characterized by painful nodules, abscesses, and sinus tract formation. Recent evidence suggests that weight management and nutritional factors may influence HS symptoms. This cross-sectional case-control study aimed to assess the impact of body composition and nutritional factors on HS severity. Materials and Methods: We included 50 patients with HS and 50 matched controls comparable in body mass index (BMI), sex, and age. The data collected included 3-day food records, a food frequency questionnaire, 24 h physical activity records, Mediterranean Diet Adherence Screener (MEDAS) scores, body composition, and anthropometric measurements. The macronutrient and micronutrient intake, as well as dietary glycemic index (GI), were analyzed. HS severity was assessed using the Hurley staging system and the International Hidradenitis Suppurativa Severity Score System (IHS4). Results: HS patients exhibited significantly lower adherence to the Mediterranean diet and a higher dietary GI compared to controls. Their micronutrient intake was also reduced, while the consumption of junk food, dairy products, and nightshade vegetables was more frequent. The MEDAS scores and physical activity levels were negatively correlated with the IHS4 scores, while higher anthropometric measurements, dietary energy, protein, total fat, and GI showed positive correlations. The Hurley stage was negatively correlated with the MEDAS scores and positively correlated with the GI and visceral fat. In multiple regression analysis, the MEDAS score emerged as the primary variable associated with disease severity. Conclusions: These findings suggest that an increased adherence to the Mediterranean diet, intake of food with a lower GI, and maintaining an ideal body weight may positively affect HS management. Long-term studies are warranted to corroborate our findings.

Integrative approaches in the management of hidradenitis suppurativa

The etiology of hidradenitis suppurativa is not fully understood, complicating treatment strategies. Current pharmacological and surgical options are limited by patient acceptance, efficacy, safety, and cost. Integrative approaches aim to enhance standard care with safe and acceptable treatments, complementing rather than replacing therapies. This review highlights recent developments in integrative approaches including smoking cessation, dietary modifications, exercise, and psychosocial support for managing hidradenitis suppurativa effectively.

The Influence of a Plant-Based Diet on Skin Health: Inflammatory Skin Diseases, Skin Healing, and Plant-Based Sources of Micro- and Macro-Nutrients

Dietary patterns have been shown to worsen or alleviate several dermatological diseases. A well-balanced, plant-based diet is known to have anti-inflammatory, probiotic, and antioxidant properties, along with weight loss-promoting effects. Moreover, a plant-based diet has a low glycemic load, improving metabolic disease. Due to these qualities, plant-based diets may have beneficial effects on inflammatory skin conditions. In this review, we aim to discuss the possible mechanisms by which a plant-based diet reduces disease severity in psoriasis, acne, hidradenitis suppurativa, and atopic dermatitis. We also aim to clarify how a plant-based diet may influence skin healing and identify sources of vitamins, nutrients, fatty acids, and protein in a well-balanced, plant-based diet. We performed a literature search on PubMed/MEDLINE databases with the following keywords: "plant-based" OR "vegan" OR "vegetarian" OR "meat" OR "diet" AND "psoriasis" OR "hidradenitis suppurativa" OR "acne" OR "atopic dermatitis" OR "skin healing" OR "dermatology". Our findings demonstrate that plant-based foods may improve inflammatory skin diseases by supporting the gut microbiome, exerting anti-inflammatory effects, providing barrier support, and improving glycemic control. With the proper education, there is an abundance of plant-based food sources or supplements that contain riboflavin, vitamin B12, vitamin A, omega-3 fatty acids, and protein, thereby ameliorating the risk of nutritional deficiencies. Thus, a plant-based diet may have therapeutic potential in dermatology. In spite of the evidence available, there is a paucity of clinical studies focusing specifically on plant-based diets and dermatologic conditions and further investigation is warranted.

The role of diet in managing hidradenitis suppurativa: a review of current evidence and future directions

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition wish a complex pathogenesis influenced by multiple factors, including diet. This manuscript summarizes current literature on the potential role of diet in HS management. Various dietary interventions, including the Mediterranean diet, elimination diets and specific nutrient supplementation, have shown promise in individual cases and observational studies. However, the heterogeneous nature of HS and the lack of controlled prospective studies limit the ability to make general dietary recommendations. Demographic factors influencing dietary habits and HS prevalence are also discussed. While food quality appears to be a crucial factor, more research is needed to establish definitive links between specific dietary components and HS outcomes. Future controlled clinical trials are necessary to develop evidence-based dietary guidelines for HS patients, considering individual variability and demographic factors.

Evaluating dietary considerations in hidradenitis suppurativa: a critical examination of existing knowledge

Hidradenitis suppurativa (HS) is a chronic condition that can overwhelm patients, and the effectiveness of supplementary dietary treatments remains uncertain. The primary aim of this review is to explore the connection between diet and HS progression. However, it is imperative to note that the evidence supporting a substantial role of the diet in HS remains weak. Dietary alterations alone should not be considered independent solutions for managing HS. Medical therapy continues to be indispensable for adequate treatment. Research indicates that the Mediterranean lifestyle and diet may provide cost-effective and beneficial adjustments when combined with traditional therapies. Conversely, foods with a high glycemic index and dairy could worsen HS symptoms, conceivably through mechanisms linked to insulin resistance and inflammation. Zinc, known for its antioxidant properties, shows promise as an adjunct therapy. Moreover, evidence suggests a connection between vitamin D deficiency and HS severity, although the findings are inconclusive. Brewer's yeast-free diet, B12 supplementation, intermittent fasting, and reducing the intake of refined sugar and dairy merit further investigation. In conclusion, this review highlights the need for additional research because of the lack of standardized reporting of clinical effects in the studies under scrutiny. A deeper exploration of the pathophysiology focusing on dietary modifications and their potential associations with HS severity is essential. Furthermore, it is crucial to recognize that patients' willingness to experiment with new diets makes them vulnerable to fraudulent interventions, highlighting the importance of evidence-based dietary guidance.

Adherence to Hidradenitis Suppurativa Treatment

Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that requires multimodal treatment. Adherence remains a significant challenge for many patients due to complex nature of treatment, thus presenting a barrier to management success. This review summarizes the current literature on the factors associated with adherence to medications, and lifestyle behaviors in patients with HS and proposes strategies to improve adherence. In February 2023, a systematic literature search was conducted by two independent authors on PubMed and EMBASE for articles from 2000 to 2023 on hidradenitis suppurativa adherence. A total of 21 articles met inclusion/exclusion criteria for this review. Of the studies, 11 addressed systemic medication adherence, 3 addressed topical medication adherence, 2 addressed both systemic and topical medication adherence, and 5 addressed lifestyle/behavioral modification adherence. The generalizability of results was limited by differences in study design, outcome measures, and sample size. English-only articles with full texts were used. The most reported reasons for non-adherence included presence of side effects, cost of medications, low efficacy, and unclear instructions. Proposed strategies to improve adherence in HS patients include management of side effects, use of reminder systems, improved patient education, patient support groups, aid of family and caregivers, personalization of the medication regimen, and regular follow-ups with patients. PROSPERO Registration Number: CRD42023488549.

Insights into Gut Microbiome Composition in Hidradenitis Suppurativa: A Comprehensive Examination of Dietary Habits and Environmental Influences

This study explores the relationship between dietary habits, environmental influences, and gut microbiome composition in individuals with hidradenitis suppurativa (HS), a chronic inflammatory skin condition. A cohort of 80 participants, equally divided into HS patients and healthy controls, was assessed through comprehensive questionnaires capturing demographics, dietary habits, and other health-related information. Fecal samples were collected and analyzed using next-generation sequencing to examine microbiome composition. Despite previous studies suggesting gut dysbiosis in HS, this research found no significant differences in alpha-diversity and Shannon diversity index between the groups. However, significant disparities in dietary habits were observed, with HS patients showing higher sugar and milk consumption. The study also identified a significant correlation between coffee consumption and the presence of certain bacterial genera. While the study did not reveal major differences in microbiome diversity, the findings on dietary habits and specific microbiome components suggest potential targets for therapeutic intervention. These results underscore the importance of further research into the gut-skin axis and its role in HS, aiming to enhance management strategies through dietary modifications and lifestyle interventions.

Diet and physical activity as risk-reducing factors for hidradenitis suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a multifactorial inflammatory skin disease that is considered to be an immune-mediated inflammatory disease (IMID). Up till now, the impact of lifestyle on (the development of) HS has not been thoroughly investigated.

OBJECTIVES

To investigate the effect of dietary intake and physical activity (PA) on (the development of) HS.

MATERIALS AND METHODS

A nested case-control study was performed within the longitudinal Lifelines Cohort Study, that took place in the Northern Netherlands, and identified 1004 adult eligible HS patients and 5000 age-matched controls. Dietary data were collected using a validated food frequency questionnaire, subsequently translated to the Lifelines Diet Score (LLDS), alternate Mediterranean Diet Score (aMED) and Dutch Dietary Guidelines score (DDG), with higher scores reflecting healthier dietary habits. PA was measured by the Short Questionnaire to Assess Health-enhancing PA score. Logistic regression analyses were performed between dietary/PA scores, and the prevalence/development and severity of HS.

RESULTS

Compared to controls, HS patients scored lower on the LLDS [OR = 0.98; 95% CI 0.96-0.99], aMED [0.93; 0.89-0.97] and DDG [0.93; 0.88-0.97] with multivariable regression analysis. Overall, this indicates less adherence to dietary recommendations and consumption of a low-quality diet in the HS population. Lower adherence to the LLDS and DDG was also significantly associated with a higher likelihood to HS development in univariable regression analysis [0.96; 0.94-0.99 and 0.91; 0.84-0.99, respectively], and a trend of decreased adherence to the aMED [0.93; 0.85-1.02] was noted. Besides, PA levels were found significantly lower in HS patients (p ≤ 0.001).

CONCLUSIONS AND RELEVANCE

Poor diet quality and lower quantities of PA were associated with HS in the general population. Identifying dietary and PA habits of HS patients can contribute to the development of prevention strategies for HS specifically, and for IMIDs in general.

Popular Diets and Skin Effects: A Narrative Review

Numerous diets for losing weight, building strength, and managing a range of cardiovascular, neurologic, and skin diseases have become popular in recent years. The ketogenic diet and intermittent fasting in particular have shown promising results in clinical and sports medicine. The Mediterranean diet, in turn, is widely recognized for its numerous health benefits. Also popular are the paleo diet and vegan and gluten-free diets. Positive effects on inflammatory conditions, such as psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne, have been observed in patients who practice intermittent fasting or follow ketogenic or Mediterranean diets. This last choice may also protect against certain skin cancers. We review the role of several popular diets in the management of skin disorders.

[Translated article] Popular Diets and Skin Effects: A Narrative Review

Numerous diets for losing weight, building strength, and managing a range of cardiovascular, neurologic, and skin diseases have become popular in recent years. The ketogenic diet and intermittent fasting in particular have shown promising results in clinical and sports medicine. The Mediterranean diet, in turn, is widely recognized for its numerous health benefits. Also popular are the paleo diet and vegan and gluten-free diets. Positive effects on inflammatory conditions, such as psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne, have been observed in patients who practice intermittent fasting or follow ketogenic or Mediterranean diets. This last choice may also protect against certain skin cancers. We review the role of several popular diets in the management of skin disorders.

Dietary Factors and Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin condition affecting hair follicles in flexural sites. Obesity is considered to be a risk factor for HS occurrence and thought to be associated with increased severity of HS symptoms. Here, we review the literature examining the impact of dietary factors on HS. Moreover, we propose potential mechanistic links between dietary factors and HS pathogenesis, incorporating evidence from both clinical and basic science studies.

Expert consensus on priority research gaps in dietary and lifestyle factors in hidradenitis suppurativa: a Delphi consensus study

Hidradenitis suppurativa (HS) is a debilitating systemic inflammatory disease with limited treatment options. Although management through dietary and lifestyle changes is a primary interest of the HS patient community, there is lack of consensus regarding recommendations due to the paucity of evidence. To establish the priority research gaps on this topic, we performed and moderated a Delphi consensus study by integrating expert opinions and the relevant literature. Based on a literature review, research questions on dietary and lifestyle interventions in HS were constructed. HS dietary and lifestyle research questions were sent to an expert panel, consisting of 22 international members, including dermatologists, dietitians, pharmacists, and endocrinologists. Voting on the research questions was conducted using a modified Delphi technique. The primary outcome measure was whether participants could reach consensus on the priority of each research question in the HS dietary and lifestyle factors. After three rounds of surveys investigating the relationships between HS and various diet and lifestyle factors, "BMI", "Obesity", and "Smoking", reached consensus as high priority research questions. Low research priorities per consensus included "effects of iron supplements", "effects of magnesium supplements", "alcohol consumption" and "limiting Brewer's yeast intake. Smoking and obesity were identified as important research questions, concurrent to the literature indicating their association with more significant impact on disease activity. By shedding light on high priority research questions, our study provides a roadmap for further research on dietary and lifestyle modifications in HS and will help determine evidence-based lifestyle and dietary recommendations for patients with HS.

Obesity and hidradenitis suppurativa: targeting meta-inflammation for therapeutic gain

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the pilosebaceous unit. The typical patient with HS is characterized as someone with obesity, who smokes and who has nodules, abscesses and/or draining tunnels predominantly distributed in intertriginous skin. It has been established that lifestyle and genetic factors are the main pathophysiological drivers of HS. In this critical review, we explore the interrelatedness of meta-inflammation, obesity and HS and discuss if and how this relationship may be manipulated for a therapeutic end.

Association of Nutrition, Obesity and Skin

Nutrition, together with weight gain, alcohol consumption, physical activity, and other factors, is a risk factors for chronic inflammatory diseases [...].

Effects of Exercise and Dietary Modifications on Hidradenitis Suppurativa: A Systematic Review

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.

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits

Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.

Gut Microbiota in Psoriasis

Psoriasis is a chronic inflammatory skin disease with autoimmune pathogenic characteristics and is caused by chronic inflammation, which results in uncontrolled keratinocyte growth and defective differentiation. The link between the gut microbiota and immune system regulation opened a novel angle to understand the pathogenesis of many chronic multifactorial diseases, including psoriasis. Current evidence suggests that modulation of the gut microbiota, both through dietary approaches and through supplementation with probiotics and prebiotics, could represent a novel therapeutic approach. The present work aims to highlight the latest scientific evidence regarding the microbiome alterations of psoriatic patients, as well as state of the art insights in terms of microbiome-targeted therapies as promising preventive and therapeutic tools for psoriasis.

Does Mediterranean Adequacy Index Correlate with Cardiovascular Events in Patients with Advanced Chronic Kidney Disease? An Exploratory Study

The Mediterranean Diet (MD) is a healthy dietary pattern, demonstrated to reduce the risk of cancer, diabetes, cardiovascular and neurodegenerative diseases, and early death. The Mediterranean Adequacy Index (MAI) is used to measure adherence to the MD in perspective studies in the general population and correlates with cardiovascular events. The aim of this study was to calculate the MAI among patients with advanced chronic kidney disease (CKD) and correlate it with traditional uremic, microbiota-derived, and proatherogenic toxins as well as nutritional status, quality of life, and cardiovascular events. A total of 60 adult patients with advanced CKD were enrolled and their MAI was calculated. According to the median value, patients were divided into lower (l-MAI, <1.80) and higher (h-MAI, ≥1.80) MAI groups. Biochemical parameters, microbiota-derived and proatherogenic toxins (p-Cresyl sulphate, Indoxyl-sulphate, and Lipoprotein-associated phospholipase A2), nutritional status, quality of life, and cardiovascular events that occurred in the previous three years were recorded. The mean value of the MAI was 2.78 ± 2.86. The MAI was significantly higher in foreigners (median (IQR) 6.38 (8.98) vs. 1.74 (1.67), p < 0.001) and diabetic patients. The l-MAI and h-MAI groups had similar routinary blood, p-Cresyl-sulphate, Indoxyl-sulphate, and Lp-PLA2 as well as nutritional status and quality of life parameters. The MAI was not associated with previous cardiovascular events and did not correlate with cardiovascular events in CKD patients. New and nephro-tailored indexes are warranted to evaluate nutritional therapy in CKD patients.