Dietary approaches in the management of hidradenitis suppurativa: a review of current evidence in the JAAD

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition with potentially significant impacts on patient quality of life. This review evaluates current evidence regarding dietary interventions for HS management. We conducted a PubMed search using terms “hidradenitis” AND (“diet” OR “nutrition” OR “food”) AND (“JAAD” OR “Journal of the American Academy of Dermatology”). Of the 10 articles identified, 3 were excluded due to irrelevance, leaving 7 for analysis. Our findings reveal several dietary approaches with preliminary evidence of benefit, despite methodological limitations in the available research. Dairy-free diets showed associations with reduced lesion formation and inflammatory activity. Brewer’s yeast exclusion demonstrated modest improvement in disease activity for some patients, but studies included associated surgical intervention, so this may not be repeatable. Both Mediterranean diet patterns and low glycemic index approaches correlated with decreased frequency and severity of flares. Newer research demonstrates that hidradenitis suppurativa patients exhibit gut dysbiosis with reduced microbiome diversity, particularly showing elevated Bilophila genus and deficiencies in SCFA-producing bacteria, suggesting that dietary interventions emphasizing plant-based foods and fiber supplementation may offer promising therapeutic approaches. No serious adverse effects were reported with any dietary modification. The current evidence is limited by small sample sizes, varied study designs, and the absence of randomized controlled trials. This highlights a significant knowledge gap in the literature regarding nutritional approaches to HS management. Dermatology providers may consider discussing these dietary modifications as potential adjunctive approaches while acknowledging the limited nature of current evidence. Further well-designed clinical studies are urgently needed to establish evidence-based dietary recommendations for HS management.