Unlock the Surprising Link Between Hidradenitis Suppurativa and Weight Loss – What You Need to Know!

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful boils, nodules, and abscesses that typically occur in areas where skin rubs together, such as the armpits, groin, and buttocks. These lesions can persist for extended periods, enlarge, cause pain, leak foul-smelling liquid or pus, connect through tunnels under the skin, disappear and reappear, and leave scars after healing. While the exact cause of HS remains unclear, it is associated with several comorbidities, including overweight or obesity and metabolic syndrome. This article delves into the relationship between HS and weight, examining the potential benefits of weight loss in managing HS symptoms and exploring various weight loss strategies.

The Link Between HS and Weight

Research indicates a significant association between HS and body weight. Studies have shown that individuals with HS often have higher body fat, larger waist circumferences, elevated body mass index (BMI), and greater waist-to-hip ratios compared to those without the condition.

How Weight Influences HS

While being overweight doesn't directly cause HS, it can exacerbate the condition through several mechanisms:

Increased Skin Folds and Friction: Overweight individuals tend to have more skin folds, creating areas of increased friction. Larger areas of skin folds can cause friction, which can injure the skin and rupture hair follicles. These areas are generally warmer and have more moisture than other areas, making them conducive to microbial growth.
Microbial Colonization: Warm, moist conditions in skin folds can foster bacterial overgrowth, potentially worsening inflammation. The areas where friction and injury are more likely to occur are generally warmer and have more moisture than other areas. These factors can make them conducive to microbial growth.
Systemic Inflammation: Obesity triggers a low-grade, chronic inflammatory state, marked by elevated levels of pro-inflammatory cytokines like TNF-α. Research also suggests that people with overweight or obesity have higher levels of inflammation.
Hormonal Dysregulation: Weight can influence hormonal imbalances that exacerbate HS symptoms. Hormones are believed to play a role in HS, so excess body weight might make HS symptoms worse for some people.
Collagen Structure: Higher body weight can also affect the structure of collagen, a protein that helps keep skin strong. This can make the skin weaker and slow down healing from cuts or injuries.

The Potential Benefits of Weight Loss for HS

Some research suggests that losing weight can help improve HS symptoms. A study of 383 people with obesity and HS who underwent bariatric surgery showed that weight loss could reduce the prevalence and severity of symptoms. Among those who had lost weight, the number of individuals reporting HS symptoms decreased by 35%. The study also showed that there were fewer areas of boils and skin lesions in the group of people who lost weight. In addition, those who lost 15% or more of their body weight got the most relief from their HS symptoms.

Researchers believe that weight loss reduces HS symptoms because it decreases friction, microbial colonization, and inflammation.

However, it's important to note that weight loss isn't a guaranteed solution for everyone with HS. Some patients experience a reduction in HS severity with weight loss, while others do not. A survey of online forum posts showed that only 29% of people with HS who had undergone weight loss surgery saw an improvement in symptoms. Of the survey participants, 39% reported no change in symptoms. Others reported that weight loss surgery even made their symptoms worse.

Weight Loss Strategies for Individuals with HS

Weight loss can be challenging for anyone, and individuals with HS may face additional obstacles due to pain, reduced mobility, or exercise-induced flares caused by friction and sweating. If a person with HS is finding it difficult to lose weight, and diet and exercise changes are proving ineffective, weight loss surgery may be an option.

Lifestyle Modifications

Dietary Changes: There's no official "HS diet," but some research suggests that avoiding trigger foods like dairy, sugar, and highly processed items could help reduce flare-ups. Many people with HS also report success with diets, like the Mediterranean diet, which focuses on whole, nutrient-rich foods like fruits, veggies, and lean proteins. A healthy diet, like the Mediterranean diet - rich in fruits, vegetables, and lean proteins - may also help reduce inflammation. Even if changing your diet doesn’t lead to weight loss, it can still support your overall health and well-being.
Exercise: Exercising with HS isn’t always easy, especially when skin lesions cause discomfort. Light activities, like swimming or stretching, can be helpful. Wearing sweat-wicking gear may also prevent flares caused by sweating. Low-impact exercises like walking, swimming, or stretching can help with mobility and mood. However, if you have severe HS lesions, some activities, like biking, might cause friction or irritation. A doctor or physical therapist can help you find exercises that work best for you.

Weight Loss Surgery

Some people with HS may consider weight loss surgery as a way to help them achieve a more moderate weight and improve their symptoms.

Gastric Bypass: A gastric bypass leads to weight loss by restricting the amount of food that a person can consume. The surgeon will section off a very small portion of the stomach and connect it with the small intestine. These changes also cause the gut to release extra hormones that promote satiety and fullness.
Sleeve Gastrectomy: A sleeve gastrectomy is less invasive than a gastric bypass. In this procedure, a surgeon will remove about 80% of the stomach and form a banana-shaped pouch from the portion of the stomach that remains. It involves a shorter hospital stay than a gastric bypass but leads to significant, lasting weight loss.
Adjustable Gastric Band: The adjustable gastric band is a small inflatable band. A surgeon places it around the stomach to section off the upper portion of the stomach into a small pouch and keep it separate from the rest of the stomach. This procedure is reversible and less invasive, but it still aids weight loss. However, the adjustable gastric band may lead to a slower initial weight loss than other weight loss procedures. Those who undergo it must also follow a strict postoperative diet. This procedure has a lower rate of success and a higher chance of reoperation being necessary.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS): During a BPD/DS, a surgeon creates a small stomach pouch by removing a portion of this organ. They then attach part of the small intestine to the pouch, meaning that food bypasses a large part of this tube. Among the bariatric surgery options, this procedure generally causes the most significant weight loss. However, it also has a higher rate of complications and morbidity than the other procedures.

Risks of Weight Loss Surgery:

However, while some people may see their HS symptoms lessen as a result of weight loss surgery, researchers caution that these surgeries do carry risks relating to HS. For instance, weight loss surgery is not a guarantee that HS symptoms will decrease. Rapid weight loss, which is common after weight loss surgery, can cause excess loose skin. The excess skin can lead to an increase in skin folds and, therefore, areas of friction, which can increase HS symptoms.

As with any surgical procedure, weight loss surgery carries some risks, including:

Read also: Diet and Hidradenitis Suppurativa

Infection
Anesthesia-related risks
Acid reflux
Malnutrition
Stomach or bowel obstruction or perforation
Lack of weight loss
Vitamin or mineral deficiency
Internal bleeding
Injury to an organ

Additionally, people with HS may risk increasing their HS symptoms or not alleviating them.

Glucagon-Like Peptide 1 (GLP-1) Receptor Agonist Drugs

People with HS may wonder if glucagon-like peptide 1 (GLP-1) receptor agonist drugs could help. GLP-1 drugs are most commonly used to treat type 2 diabetes and obesity. Semaglutide (sold under brand names including Ozempic, Wegovy, and Rybelsus) is a common example.

GLP-1 drugs mimic the action of GLP-1, a hormone naturally found in your body. These medications:

Stimulate insulin release, which helps lower blood sugar
Have anti-inflammatory effects
Increase feelings of fullness after eating

Early research suggests that semaglutide might help people with HS, but the evidence is still very limited. A small study with 30 people found that semaglutide reduced HS flares and improved quality of life. However, bigger studies are needed to be sure. While these drugs show promise, they are not a standard treatment for HS.

Additional studies of other GLP-1 drugs, including liraglutide (Saxenda, Victoza), have shown promising results. In one small study, 14 people with HS who took liraglutide for three months experienced reduced HS severity and improved quality of life. However, because these studies had small sample sizes, more research is needed before GLP-1 drugs can be considered a standard treatment for HS. If you’re interested in trying one, talk to your healthcare provider.

Metabolic Endoscopy

Metabolic endoscopy is a growing field aiming to aid weight loss through endoscopic minimally invasive, nonsurgical means. In a case series, an intragastric balloon (IGB) was used to aid weight loss in women with Hurley stage 3 and stage 1 HS, along with a simplified low-carbohydrate template diet, resulting in clinical improvement in HS and markedly improved quality of life. The "No-P template" involves avoiding all alcohol and removing foods starting with the letter "P" - potatoes, pasta, pizza, plantain, pies, pastries, puddings, pulses, and pilau rice or any form of rice, poppadum’s, panipuri, Peshwari naan (or any form of bread). The patients were advised to eat fresh fish, meat, vegetables, and salads plus fruit 3× times a week.

Additional Benefits of Weight Loss

Weight loss has many benefits, aside from improving HS symptoms. Additional benefits of weight loss include:

Lower risk of diabetes
Improved cardiovascular health and reduced risk of heart disease
Better mobility
Less joint pain
Improvement in metabolic function
Better blood sugar control

The Gut-Skin Axis and HS

Emerging research suggests a connection between the gut microbiome and HS. A recent report has suggested differences in both the gut and skin microbiota in patients with HS compared with healthy individuals. It is proposed that the insertion of an IGB concomitant with reduced carbohydrate and high-fiber food intake might also revert gut dysbiosis sufficient to improve HS severity. Further research is needed to fully understand the role of the gut microbiome in the pathogenesis of HS.

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