Hidradenitis: when the skin speaks about inflammation and metabolism

Hidradenitis suppurativa is a chronic inflammatory skin condition that most commonly occurs in areas such as the armpits, groin, under the breasts, or in areas with increased friction.

It manifests as painful nodules, local inflammation, episodes of suppuration, recurrent abscesses, and in more advanced forms, fistulas or scars.

Is hidradenitis just a skin problem?

Not always. Increasing evidence shows that hidradenitis can be associated with systemic inflammation, excess weight, metabolic syndrome, and insulin resistance.

In other words, in some people, the skin disease may be sustained by an inflammatory metabolic environment.

The link with insulin resistance

Insulin resistance means the body needs more insulin to keep blood sugar within normal limits. This chronic hyperinsulinemia can promote inflammation, hormonal imbalances, and blockage of hair follicles.

In hidradenitis, this can contribute to:

• persistent chronic inflammation;
• worsening of skin lesions;
• more frequent relapses;
• slower healing;
• association with excess weight and metabolic syndrome.

Which tests can indicate insulin resistance?

For evaluating the metabolic environment, the following can be useful:

• fasting blood glucose;
• fasting insulin;
• HOMA-IR index;
• glycated hemoglobin HbA1c;
• triglycerides;
• HDL cholesterol;
• abdominal circumference.

Elevated triglycerides, low HDL, and increased basal insulin may suggest the presence of insulin resistance.

Nutritional approach

In people with hidradenitis and signs of insulin resistance, a logical strategy is to reduce foods that strongly increase insulin.

• reducing sugar;
• reducing refined flour products;
• avoiding frequent snacking;
• less frequent and better-structured meals;
• weight loss, if there is excess weight;
• intermittent fasting, where well tolerated.

This approach does not directly treat the lesions but can reduce the inflammatory and metabolic environment that sustains the disease.

Berberine

Berberine is a natural compound studied for its effects on carbohydrate and lipid metabolism. It may support insulin sensitivity, help control blood sugar, and contribute to reducing triglycerides.

In hidradenitis, berberine may be particularly interesting especially when there is:

• insulin resistance;
• elevated triglycerides;
• excess weight;
• craving for sweets;
• metabolic syndrome.

They should not be viewed as specific treatments for hidradenitis but as possible metabolic support.

Curcumin and boswellia

Hidradenitis is a chronic inflammatory disease, which is why natural substances with anti-inflammatory effects can be considered as adjuncts.

Curcumin can support the reduction of systemic inflammation and also has interesting effects on metabolism. Forms with increased bioavailability, such as liposomal or phytosomal, may be preferable to simple curcumin.

Boswellia contains boswellic acids, compounds with anti-inflammatory effects, frequently used in chronic inflammatory contexts.

In hidradenitis, curcumin and boswellia should not be presented as curative treatments but as general anti-inflammatory support.

Local zeolite

In lesions that suppurate or remain moist, the local application of an absorbent powder can have practical logic.

Zeolite, through its absorbent properties, can help with:

• absorbing local moisture;
• reducing discomfort caused by secretions;
• maintaining a drier area;
• reducing odor associated with exudate.

Local zeolite does not treat the cause of hidradenitis and does not replace dermatological consultation, but it can be considered as a local adjunct for comfort and moisture control.

A comprehensive approach

In hidradenitis, a logical approach could include:

• assessment of insulin resistance;
• reducing sugar and flour intake;
• weight loss, if applicable;
• supporting insulin sensitivity;
• natural anti-inflammatory support;
• gentle local hygiene;
• reducing friction and local moisture;
• dermatological consultation for moderate or severe forms.