Transformative nutrition: the role of food in an inflammatory skin disease

What happens on the skin often begins much deeper. In women living with chronic inflammation, pain, and recurrent skin lesions, the root of the problem may be linked to hormonal, immune, and metabolic imbalances. This is the case with hidradenitis suppurativa (HS), a condition that goes far beyond dermatology and severely impacts quality of life. In this context, nutrition emerges as a key tool—not as a miracle cure, but as a powerful ally to reduce symptoms, control flares, and regain well-being.

Hormones and Skin: An Inflammatory Connection Below the Surface

HS disproportionately affects women, especially during reproductive age. Hormonal fluctuations related to the menstrual cycle, polycystic ovary syndrome (PCOS), and metabolic conditions like obesity can worsen the disease. Hormones such as androgens activate the inflammasome, promoting a chronic inflammatory cascade in the skin. This hormonal imbalance not only triggers lesions but also affects the emotional well-being of patients.

The link to mental health is undeniable: physical symptoms combine with high levels of anxiety, depression, and sexual dysfunction, exacerbating the disease’s impact on daily life. Thus, understanding and modulating hormonal and metabolic factors—including diet—is essential to improve the clinical course of HS.

Your Plate Is Also Medicine: The Therapeutic Role of Food

An anti-inflammatory diet is more than a trend—it’s a science-backed strategy for managing HS. Current evidence shows that the Mediterranean diet—rich in vegetables, fruits, legumes, fatty fish, olive oil, and low in red meat and sugars—can modulate systemic inflammation and reduce disease severity.

Research highlights that women with HS who follow a Mediterranean or hypocaloric diet significantly improve their symptoms. This is linked to reductions in body mass index (BMI), inflammatory markers such as TNF-α, and positive changes in gut microbiota.

In addition, a very-low-calorie ketogenic diet (VLCKD) has shown benefits in women with HS and obesity. In one study, a 12-week intervention with VLCKD not only reduced HS severity (measured with the IHS4 score), but also improved metabolic function. This type of diet lowers circulating insulin and may help control hyperandrogenism, especially beneficial for patients with associated PCOS.

Another important finding involves the role of the gut microbiota and its metabolites. People with HS have been shown to experience gut dysbiosis, with lower diversity of beneficial bacteria and a higher presence of pro-inflammatory species. This imbalance promotes the production of compounds like trimethylamine N-oxide (TMAO), linked to higher systemic inflammation and greater disease severity. A diet high in prebiotic fiber, polyphenols, and low in processed meats may help restore microbial balance.

Furthermore, nutrition can help reduce the load of advanced glycation end-products (AGEs)—pro-inflammatory compounds—especially by limiting ultra-processed foods and high-heat cooking methods. AGEs have been associated with worsening of inflammatory skin conditions like HS.

Nutrition as Part of an Integrated Treatment Approach

Although there’s no “one-size-fits-all” diet for HS, what’s clear is that adapting dietary patterns to each patient’s inflammatory, hormonal, and metabolic needs is crucial for long-term clinical control. This requires professional nutritional guidance, with personalized plans that go beyond weight management to include gut health, hormone regulation, and emotional well-being.

It’s not enough to treat the skin—we must treat the whole body. Proper nutrition can be a powerful tool to restore quality of life, enhance medical treatment response, and give patients back control over their health.

Addressing HS in women means looking beyond skin lesions. Diet, metabolism, microbiota, and hormones are deeply interconnected in this disease. Nutrition is not a minor complement, but a fundamental pillar in the comprehensive therapeutic approach these patients deserve.