Dietary modifications are complementary treatments. These may include the:
Zero dairy diet
A zero dairy diet contains no dairy products (e.g. milk, cream, cheese).
It may prevent the worsening of existing HS lesions, as well as the development of new ones (Danby, 2015).
A diet containing dairy may increase levels of insulin-like growth factors (IGF-1), increasing HS lesions’ sensitivity to androgens. This may inflame glands, leading to HS (Danby, 2015).
Low Glycemic Index (GI) diet
A low GI diet is low in simple sugars.
It may prevent the worsening of existing HS lesions, as well as the development of new ones (Danby, 2015).
A diet containing simple sugars may increase insulin levels, increasing HS lesions’ sensitivity to androgens. This may inflame glands, leading to HS (Danby, 2015).
Brewer’s yeast-free diet
A brewer’s yeast-free diet contains no food or drinks prepared with brewer’s yeast (e.g. bread, pizza, pastries, beer, wine, fermented cheese).
It may help reduce HS symptoms.
Although controversial and requiring further studies, some patients with HS may develop an abnormal immune response to a component of brewer’s yeast, leading to increased inflammation in the form of HS (Cannistrà, Finocchi, Trivisonno, & Tambasco, 2013).
Zinc gluconate has anti-inflammatory properties that work on superficial and deep lesions (Brocard, Knol, Khammari, & Dréno, 2007; Cervantes, Eber, Perper, Nascimento, Nouri, & Keri , 2018).
May suppress HS symptoms, but not curative (Brocard, Knol, Khammari, & Dréno, 2007; Zouboulis C. C., et al., 2015).
Zinc gluconate reduces the activity of pro-inflammatory cytokines, proteins involved in the immune response promoting inflammation (Brocard, Knol, Khammari, & Dréno, 2007).
Also reduces cellular damage by neutralizing highly reactive molecules called free radicals (Brocard, Knol, Khammari, & Dréno, 2007).
Vitamin D is an activator of the skin’s immune response that increases protein and receptor levels involved in killing and/or inhibiting bacteria and/or viruses (Guillet, et al., 2015). It is recommended for individuals with low levels of vitamin D.
Smoking cessation is recommended and may improve health outcomes.
Screening for obesity may improve health outcomes.
HS patients have reported flare-ups at areas of the skin where clothing is tight due to friction (Zouboulis C. C., et al., 2015).
Zero dairy diet
Anyone with any stage of HS.
Low Glycemic Index (GI) diet
Anyone with any stage of HS.
Brewer’s yeast-free diet
Anyone with any stage of HS.
May be used as a maintenance therapy in those with Hurley stage I/II (DynaMed Plus, 2016; Zouboulis C. C., et al., 2015).
Those who have not found results with other therapies (Brocard, Knol, Khammari, & Dréno, 2007).
Zero dairy diet
Talk to your health care provider before starting a new diet regimen.
Low Glycemic Index (GI) diet
Talk to your health care provider before starting a new diet regimen.
Brewer’s yeast-free diet
Talk to your health care provider before starting a new dietary regimen.
Those with allergies and/or sensitivity to zinc.
Those with Hurley stage III (DynaMed Plus, 2016).
Zero dairy diet
Level of Evidence: Level III
Strength of recommendation: “C” rating
No formal clinical trials have tested the efficacy of zero dairy diets for HS.
Among 47 patients who personally tested a dairy-free diet, 83% improved and none worsened, although there was potential for bias (Danby, 2015).
Low Glycemic Index (GI) diet
No formal clinical trials have tested the efficacy of low glycemic diets for HS.
Brewer’s yeast-free diet
Level of Evidence: Level II
Strength of recommendation: “C” rating
Stabilization of HS symptoms and regression of HS lesions was observed in all 12 HS patients who underwent surgery or localized treatments, and followed a brewer’s yeast-free diet for 12 months. Worsening was observed after consumption of brewer’s yeast foods (Cannistrà, Finocchi, Trivisonno, & Tambasco, 2013).
HS patients with higher adherence levels to brewer’s yeast-free diet improved. Only small changes in weight prior to and 3 months following the start of the diet were observed, suggesting improvement of HS symptoms is linked more closely to adherence to the brewer’s yeast-free diet vs. weight loss (Colboc, et al., 2016).
Level of Evidence: Level II
Strength of recommendation: “C” rating
Significant improvement was observed following oral zinc gluconate and topical triclosan administration for 12 weeks in 54 HS patients (Hessam, Sand, Meier, Gambichler, Scholl, & Bechara, 2016).
Among 22 HS patients who received oral zinc gluconate, the majority improved (Brocard, Knol, Khammari, & Dréno, 2007).
Level of Evidence: Level II
Strength of recommendation: “C” rating
The majority of vitamin D deficient HS patients who received supplements (N = 14) improved after 6 months (Guillet, et al., 2015).
Level of Evidence: Level III
Strength of recommendation: “C” rating
Improvement was noted in one patient after 2 months of smoking cessation and after 3 months in another (Simonart, 2010).
Level of Evidence: Level II
Strength of recommendation: “C” rating
Following bariatric surgery, 11 of 35 HS patients reported a decrease in symptoms (Kromman, Ibler, Kristiansen, & Jemec, 2014).
Improvement was noted in a male and female HS patient following weight loss by bariatric surgery and dietary changes, respectively (Thomas, Gordon, & Mortimer, 2014; Boer, 2016).
Level of Evidence: Level III
Strength of recommendation: “C” rating
Among 110 surveyed HS patients, 16% reported worsening due to “tight clothing, friction”, whereas 11% experienced relief from “loose/cotton clothing/cleanliness/drying/cold” (von der Werth & Williams, 2000).
Level of Evidence: Level II
Strength of recommendation: “C” rating
No significant differences were reported between 40 HS patients and their controls who used hair removal chemicals, deodorants, and talcum powder prior to the onset of HS (Morgan & Leicester, 1982).
6 of 11 patients who used an antiperspirant or deodorant prior to developing HS reported adverse reactions, although there was potential for recall bias (Edlich, Silloway, Rodeheaver , & Cooper, 1986).
While some patients feel that shaving, deodorants, and antiperspirants are triggers for their disease, many are able to tolerate them well. Avoidance is not necessary for all patients, but should be considered when a patient has noticed a pattern of flares relating to them.
Zero dairy diet
Serious: None.
Other: Bone thinning, as a dairy-free diet leads to lower levels of calcium, protein, and vitamin D. Consider alternative sources for these nutrients (Lexicomp).
Pregnancy risk according to the U.S. Food & Drug Administration (FDA):
Low Glycemic Index (GI) diet
Serious: None.
Other: Weight loss and nutrient deficiency, as low GI foods have lower fiber levels. Consider alternative sources for these nutrients (Lexicomp).
Pregnancy risk according to the U.S. Food & Drug Administration (FDA):
Brewer’s yeast-free diet
Serious: None.
Other: Nutrient deficiency, as brewer’s yeast contains vitamins and minerals. Alternative sources for these nutrients should thus be considered.
Pregnancy risk according to the U.S. Food & Drug Administration:
Serious:
Other:
Pregnancy risk according to the U.S. Food & Drug Administration:
Zero dairy diet
It may take some time to see results when dietary changes are made.
Some individuals may be unable to make recommended dietary changes due to other health conditions.
Low Glycemic Index (GI) diet
It may take some time to see results when dietary changes are made.
Some individuals may be unable to make recommended dietary changes due to other health conditions.
Brewer’s yeast-free diet
It may take some time to see results when dietary changes are made.
Long-term treatment may require modification based on efficacy and gastrointestional side effects (DynaMed Plus, 2016; Zouboulis C. C., et al., 2015).