9 Diet Dos and Don’ts for Hidradenitis Suppurativa

If you have hidradenitis suppurativa (HS), a chronic skin condition that causes painful lumps and scarring, anything that can help your symptoms can provide relief.

Dietary changes can help control inflammation and minimize flares in some patients, says So Yeon Paek, MD, FAAD, an assistant clinical professor at Texas A&M College of Medicine and physician at Dermatology Physicians of Dallas and Plano.

“It is certainly far from a cure for the disease but may help to reduce flares and, in milder disease — what we call Hurley stage 1 or 2 disease — can actually lead to significant improvement,” she says.

There is no standard diet for HS, and much more research is needed to determine what works best and for whom. Trial and error is often involved in determining an optimal eating pattern. In general, though, a healthy, nutritious diet low in processed foods can help reduce inflammation, an important component of HS management. You may also find relief if you eliminate specific foods from your diet.

“Weight and obesity play a big role in HS, and there is good evidence to suggest that weight loss — even losing about 15 percent of body weight — can lead to an improvement of HS,” says Dr. Paek. If you’re overweight or obese, weight loss can help reduce friction in the skin folds where HS occurs and your inflammation overall, she says.

Discuss the following “dos and don’ts” with your doctor to see if any might be a fit for you.

1. Do Keep a Food Diary to See Which Foods May Affect Your Symptoms

By writing down what you eat and noting the severity of your symptoms, you can glean important clues about which foods may cause flares or make them worse. Not everyone has the same trigger foods, so it’s helpful to develop a personalized log and show it to your doctor at your next visit. “You don’t want to just restrict nutritional intake without consulting a physician,” says Paek. “There might be risks to doing that, and it’s a very individual situation, so I think it’s good to show that to a healthcare provider. You can discuss the potential role for certain foods, talk about any data or evidence in the literature to suggest a connection, and then go from there.”

Your doctor might recommend an elimination diet, in which you completely cut one food or food group from your diet at a time so you can see how each affects you, says Paek. Be patient because these diets don’t work instantly. It can take weeks or even months to see improvement.

2. Don’t Forget About Fiber

3. Do Ask Your Doctor About Eliminating Dairy

Dairy foods contain proteins and hormones that have been linked to inflammation in follicular ducts below the surface of the skin and increased sebum (i.e., oil) production, says Paek. Some HS patients notice an improvement in their symptoms within weeks of eliminating dairy.

4. Don’t Eat Too Many Added Sugars or Refined Carbs

5. Do Consider Eliminating Foods That Contain Brewer’s Yeast

6. Don’t Skip Foods Rich in Omega-3 Fatty Acids

7. Do Consider Reducing Your Intake of Nightshades

Some people with HS find relief when they cut out foods in the nightshade family, such as potatoes, tomatoes, eggplant, and peppers. The theory is that these foods may increase gut permeability and lead to a leaky gut, which can put your body in a more inflammatory state, says Paek.

While more patients benefit from a diet free of brewer’s yeast than one free of nightshades, this one could be worth a try because it’s easier, says Paek. You can substitute with other nutritious veggies that aren’t in the nightshade family.

8. Don’t Take Supplements Without First Talking to Your Doctor

9. Do Ask Your Doctor or Dietitian if a Specific Diet May Help

“Something that is beneficial for this other immune-mediated condition, Crohn’s, may also be beneficial for HS, so I do have patients who have both conditions and have tried this specific diet,” says Paek. “In popular terms, it’s a paleo diet, but it’s very similar to what a Crohn’s-specific diet is: nut-free, gluten-free, grain-free, legume-free, and nightshade-free.”

You could also ask about a keto diet, which is low in carbs and high in fat. While there’s no specific research linking it to HS, it could be beneficial if it helps you reduce excess weight. Another possibility is the autoimmune protocol diet, which is similar to paleo and designed for autoimmune conditions and inflammation reduction.

“It’s critical to work with a healthcare provider to make sure that you’re not engaging in a dietary change that may negatively affect health overall,” says Paek. “Some patients need to take in certain food groups for various reasons, and we don’t want to compromise overall health by engaging in certain diets.”

The bottom line? “The focus should be on common things: Reduce consumption of high-sugar foods, focus on healthier eating choices, consider eliminating certain specific foods, and supplement if there is a known deficiency, such as vitamin D,” says Paek.

It’s also important to remember that dietary changes may not necessarily help everyone. “That’s why the recommendations are not universal,” says Paek. “They’re just recommendations, not guidelines for care.” Think of dietary modification as just one part of your overall HS management strategy and healthy lifestyle.

The Takeaway

• Adjusting your diet can be a valuable part of your HS treatment plan to help reduce inflammation and ease symptoms.
• There is no one-size-fits-all diet, but experimenting with anti-inflammatory foods, such as those in the Mediterranean diet, and keeping a food diary can help identify what works for you.
• Some simple changes, such as reducing processed foods and sugary beverages, might help provide relief for your symptoms.