PCOS And Hidradenitis Suppurativa: What Women Need to Know

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One of the lesser known skin problems in women with polycystic ovary syndrome (PCOS) is Hidradenitis Suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh). This chronic inflammatory skin condition in both men and women is believed to be both autoimmune and hormone related.  Newer research is showing the impact of diet in managing this condition.

What is Hidradenitis Suppurativa?

Pea-sized or larger lumps above and beneath the skin develop around hair follicles, and in places where the skin rubs together such as under the arms, thighs, groin, under breasts, and between buttocks.

These unsightly lumps can be inflamed and painful, even breaking open, releasing a foul-smelling pus. Those who experience HS report lumps being slow to heal.

In women, the lumps usually start around puberty and can worsen over time. Lumps can be connected by tunnels under the skin and can spread to other areas.

Those who have HS not only suffer from the physical pain but emotional pain of this chronic condition as well. HS can be an embarrassing and frustrating condition to cope with.

Treatment Options for Hidradenitis Suppurativa

Often overlooked, HS has been traditionally treated with medications such as antibiotics, as well as laser therapy or surgery. However, these treatments usually offer temporary relief as most people will experience a return in symptoms. Now a variety of treatments used together is believed to be an effective way to treat and prevent HS flare-ups from occurring. Treatment may be focused at targeting several aspects of HS including decreasing the bacterial load and the immune response, altering the hormonal balance, and improving wound healing.

A hormone imbalance involving higher androgens has been linked to HS. More emphasis has been placed at finding effective antiandrogen treatments which may improve HS. A study in the Journal of Cutaneous Medicine and Surgery found that antiandrogen therapy was superior to oral antibiotic therapy (55% vs 26%) in treating HS.

High levels of insulin are correlated with higher androgens among women with PCOS; lowering insulin levels can reduce androgen levels. Androgens (and insulin) can be lowered with diet, exercise, and weight loss. Weight loss has shown to improve HS as well.

Nutrition Recommendations for Hidradenitis Suppurativa

Research examining the link between HS and diet is sparse. One study published in Surgery involved 12 people with HS found that avoidance of wheat and brewer’s yeast for 12 months, showed an immediate reduction and stabilization of symptoms. An immediate recurrence of skin lesions occurred in the individuals following accidental or voluntary consumption of beer or other foods containing brewer's yeast or wheat. 

Since HS is an inflammatory condition, following an anti-inflammatory diet may play a role in treating HS. Following a FODMAPs diet by eliminating hard to digest “trigger” foods which cause inflammation should be considered. In addition, the following nutrition strategies may help to reduce inflammation in HS:

  • Avoid sugar, white flour, and wheat.
  • Avoid refined or processed high glycemic index foods.
  • Consume a diet rich in colorful fruits and vegetables.
  • Eat cold water or fatty fish like salmon, tuna, or trout at least twice a week.
  • Include plenty of unsaturated fats into your diet like avocado, olive oil, nuts, and seeds.

Do you suffer from HS? What has helped you?

Sources

Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD. Hidradenitis Suppurativa and the Metabolic Syndrome A Comparative Cross-sectional Study of 3,207 Patients. Br J Dermatol. 2015 Mar 11.

Kraft JN, Searles GE. Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy. J Cutan Med Surg. 2007 Jul-Aug;11(4):125-31.

Gill L1, Williams M2, Hamzavi I2.Update on hidradenitis suppurativa: connecting the tracts. Prime Rep. 2014 Dec 1;6:112.

Boer J. Resolution of hidradenitis suppurativa after weight loss by dietary measures, especially on frictional locations. J Eur Acad Dermatol Venereol. 2015 Mar 2.

Grant T: The Hidden Plague: A Field Guide For Surviving and Overcoming Hidradenitis Suppurativa. New York: Primal Nutrition; 2013.

Cannistrà C, Finocchi V, Trivisonno A, Tambasco D. New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer's yeast-exclusion diet. Surgery. 2013 Nov;154(5):1126-30.

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