Patients with hidradenitis suppurativa (HS) are commonly told to eat healthy to improve their disease severity. However, with so many dietary options in this day and age, what does an HS-friendly diet even look like? An article in the November Journal of Drugs in Dermatology shares research analyzing several diets and their impact on HS disease severity, as well as the impact of vitamin and mineral supplementation in patients who are deficient. The article also addresses the impact of fasting, specifically Ramadan fasting, in lesion reduction.
I interviewed the article’s authors, who are all from the UAB Heersink School of Medicine: medical students Jordan Beam and Ishika Patel, MS, and Associate Professor of Dermatology Lauren Kole, MD.
What led you to want to review current research on diet and HS?
This project grew out of our shared interest in a promising yet underexplored aspect of hidradenitis suppurativa (HS) management. Many patients reported symptom improvement after dietary changes, but couldn’t identify which ingredients made the difference, underscoring the need for clearer guidance. As awareness of HS grows, diet often enters the conversation early, but is easily overlooked once pharmacologic therapies begin. We wanted to highlight diet’s role as a powerful adjunct that can reduce systemic inflammation and support long-term disease control. By examining the inflammatory and anti-inflammatory properties of specific dietary components, we aim to provide practical, evidence-based insights that clinicians can integrate into comprehensive HS management.
HS discussions often focus on the genetic or immune system factors at work in HS. Why, up to this point, has diet not been part of the conversation?
When HS was first described, dietary triggers were commonly noted among patients. However, as systemic treatments were developed and approved, the discussion gradually shifted toward genetic and immune system pathways that influence treatment response. While patients have long been advised to avoid foods that worsen their symptoms and maintain a well-balanced diet, there’s been less clarity on what that “well-balanced” diet entails. Our goal was to highlight foods that have shown benefit in smaller HS studies, such as brewer’s yeast and dairy-free, Mediterranean, and very-low calorie ketogenic diets. Since many of the studies have small sample sizes, generalizability remains limited, but the results are nonetheless promising and warrant further investigation.
When you mention the Western diet, you include leucine. What foods contain leucine, and how is leucine connected with HS?
Leucine can be found in high protein foods, such as meat, poultry, eggs, and dairy. Leucine upregulates certain enzymes in the lipogenesis pathway, specifically RagGTPases and mTORC1 that activate mTOR signaling. This in turn increases activity, which produces sterol regulatory element-binding protein (SREBP), a transcription factor involved in lipid synthesis within sebaceous glands. This activity promotes keratinocyte proliferation and pilosebaceous plugging, initiating abscess formation in HS patients. Reducing leucine-rich food intake may therefore help mitigate mTOR-driven inflammation and limit new lesion formation.
We know there’s evidence that dairy consumption is associated with acne. How does dairy affect HS?
Dairy products are rich in casein, a primary milk protein that elevates insulin-like growth factor 1 (IGF-1) and increases androgen receptor activity. Since HS has a known androgen-mediated component, consuming foods that amplify androgen signaling may worsen follicular plugging and abscess formation. Thus, consuming products that promote the activation of androgen receptors can exacerbate follicular plugging and abscess formation. Studies have shown that most HS patients who limit or eliminate dairy products experience symptom improvement, and none worsened. This suggests that a dairy-free diet may help minimize one of the hormonal contributors to HS, particularly in patients who identify dairy as a personal trigger.
You also looked at brewer’s yeast. What foods contain brewer’s yeast, and what did the research show in connection with HS?
Brewer’s yeast containing foods include wine, beer, baked goods, fermented cheese, and some mushrooms. Research suggests that brewer’s yeast can trigger immune reactivity in susceptible individuals. In one study, patients who followed a brewer’s yeast-free diet experienced symptom improvement, but symptoms recurred once the brewer’s yeast containing products were reintroduced. These findings indicate that avoiding brewer’s yeast may reduce inflammation and help prevent HS flares in patients sensitive to it.
In addition, you analyzed research on the Mediterranean Diet and the very-low calorie ketogenic diet. Overall, what does the research say about these diets and HS?
HS can often be found with other proinflammatory conditions, such as diabetes mellitus, psoriasis, alopecia, and metabolic syndrome. The Mediterranean Diet includes limiting consumption of products that exacerbate systemic inflammation, such as processed foods, sugars, and red meat, and eating a diet rich in fruits, vegetables, whole grains, fish, and healthy fats. A small study on the very-low calorie ketogenic diet demonstrated notable improvement in about one month, with patients showing a significant decrease in Sartorius score. Although data are limited, these findings suggest that both dietary patterns may support HS improvement by targeting systemic inflammation and blocking metabolic dysregulation.
You also looked at vitamin and mineral supplementation. What does the research show?
Some patients with HS have been found to have low levels of vitamin D and zinc. Studies in which these deficiencies were corrected with oral supplementation have shown encouraging results, with some patients reaching complete response. For instance, patients started on zinc gluconate 90mg daily who maintained clinical improvement for four months could taper their dose by 15mg every two months. This highlights the potential value of identifying and correcting micronutrient deficiencies as a low-risk, early stage approach for HS.
Finally, you looked at the research on fasting, specifically Ramadan fasting. What did you learn?
Ramadan fasting entails abstaining from food and drink from sunrise to sunset for one month. This type of intermittent fasting has been shown to reduce proinflammatory cytokines and enhance regulatory T-cell (Treg) activity. Similar anti-inflammatory effects have been documented in conditions such as psoriasis, and one study found that 70% of HS patients practicing Ramadan fasting for a month experienced a reduction in severe lesions. This suggests fasting may play a supportive role in managing HS by modulating immune activity.
Overall, what should dermatology clinicians know about diet and HS, and how should this information change how they counsel their patients?
Clinicians frequently encourage patients to maintain a balanced diet and active lifestyle, but for individuals managing a chronic condition like HS, those general recommendations may feel too nonspecific. Reviewing specific dietary patterns with emerging evidence of benefit allows dermatologists to tailor guidance to each patient’s needs and triggers. Diets such as Mediterranean, dairy and brewer’s yeast-free, and very-low calorie ketogenic have demonstrated benefit and can be offered as adjunctive, non-invasive options for motivated patients. Dietary modification can be especially valuable for patients seeking to limit systemic medications or to enhance outcomes from existing therapies.
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