Hidradenitis: When the Skin Reveals 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 subject to increased friction.

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

Is hidradenitis suppurativa just a skin problem?

Not always. A growing body of evidence suggests that hidradenitis suppurativa may be associated with systemic inflammation, obesity, metabolic syndrome, and insulin resistance.

In other words, in some people, skin conditions may be exacerbated by an inflammatory metabolic state.

The link to insulin resistance

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

In hidradenitis suppurativa, this can contribute to:

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

Which tests can indicate insulin resistance?

The following may be useful for assessing metabolic status:

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

Elevated triglycerides, low HDL, and elevated fasting insulin levels may suggest the presence of insulin resistance.

Nutritional Approach

For people with hidradenitis suppurativa and signs of insulin resistance, a logical strategy is to cut back on foods that cause a sharp spike in insulin levels.

• reducing sugar intake;
• reducing the consumption of refined grains;
• avoiding frequent snacking;
• less frequent but more structured meals;
• weight loss, if overweight;
• intermittent fasting, where it is well tolerated.

This approach does not directly treat the lesions, but it can reduce the inflammatory and metabolic conditions that sustain the disease.

Berberine

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

In hidradenitis suppurativa, berberine may be of particular interest when the following conditions are present:

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

It should not be viewed as a specific treatment for hidradenitis suppurativa, but rather as a potential metabolic support.

Curcumin and boswellia

Hidradenitis suppurativa is a chronic inflammatory disease, which is why natural substances with anti-inflammatory properties may be considered as adjunctive treatments.

Curcumin may help reduce systemic inflammation and also has interesting effects on metabolism. Forms with increased bioavailability, such as liposomal or phytosomal forms, may be preferable to plain curcumin.

Boswellia contains boswellic acids, compounds with anti-inflammatory properties that are commonly used to treat chronic inflammatory conditions.

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

Local zeolite

For lesions that are oozing or remain moist, the topical application of an absorbent powder may be a practical approach.

Zeolite, thanks to its absorbent properties, can help:

• absorption of local moisture;
• reducing discomfort caused by secretions;
• keeping the area drier;
• reduction of the odor associated with exudate.

Local zeolite does not treat the underlying cause of hidradenitis suppurativa and is not a substitute for a dermatological consultation, but it can be considered as a local adjunct to help manage discomfort and control moisture.

A comprehensive approach

In hidradenitis suppurativa, a logical approach might include:

• assessment of insulin resistance;
• cutting back on sugar and starchy foods;
• weight loss, if applicable;
• supporting insulin sensitivity;
• a natural anti-inflammatory agent;
• gentle oral hygiene;
• reducing friction and localized moisture;
• dermatological consultation for moderate or severe cases.