Subjects:
Diet in HS
Diet in hidradenitis suppurativa: a review of published and lay literature
Synopsis:
Hidradenitis suppurativa (HS) is a chronic, recurring, inflammatory skin disorder resulting in skin abscesses and sinus tracts of the skin folds. Hidradenitis suppurativa remains a disease with limited treatment options. Management of disease activity with dietary modification has been of considerable interest to the HS patient community. Limited evidence exists to support dietary changes for treatment of HS. Strategies such as eliminating dairy products, limiting simple carbohydrate and sugar intake, and avoiding nightshades (Solanaceae) and foods containing brewer’s yeast have been reported to be helpful in some patients. Several supplements have also been touted as beneficial. Herein, we review the existing dietary recommendations in both peer-reviewed and lay literature in an attempt to consolidate and evaluate existing information, while stimulating further inquiry into the role of diet in HS. Although dietary modifications are often of considerable interest to HS patients, there is a paucity of data regarding diet as it relates to HS. It is unclear whether diet may prove to be of value in limiting the severity of HS. Further research is needed to determine the potential benefits of these dietary changes.
Research Synopsis:
https://pubmed.ncbi.nlm.nih.gov/31006861
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https://drive.google.com/file/d/1NC4-foruvJvHfzGyNDC_8zrz1bi5Q_fN/view?usp=drivesdk
Dietary & metabolic factors in the pathogenesis of HS
Dietary and metabolic factors in the pathogenesis of hidradenitis suppurativa:
a systematic review
Synopsis:
Hidradenitis suppurativa (HS) is a systemic recalcitrant inflammatory condition characterized by debilitating lesions with high morbidity. Its known association with obesity and smoking indicate correlation with other environmental factors, such as diet, suggesting a larger role for lifestyle modifications in disease treatment. This study seeks to assess the contribution of weight loss and dietary intake in HS management. A primary literature search was conducted using PubMed, Web of Science, and CINAHL in November 2018 to include association and intervention studies on the influence of diet and weight on HS. Twenty-five articles were included. Meta-analysis of nine case-control studies across Asia, Europe, and the United States showed that HS patients are four times more likely to be obese compared to the general population; random effects pooled odds ratio 4.022 (2.667-6.065), P < 0.001. Five articles assessed weight-loss interventions and revealed mixed findings. The remaining articles included three association studies on micronutrient levels, eight dietary intervention studies, and one article analyzing both micronutrient association and dietary intervention. Included articles in this systematic review reveal that low serum zinc and vitamin D levels are associated with increased lesion count in HS. Supplementation of zinc, vitamin D, vitamin B12, or exclusion of dairy or brewer’s yeast can be effective in partial or complete lesion resolution. Reviewed data show that weight loss from bariatric surgery may lead to HS improvement but often results in more severe malnutrition that worsens or even leads to new onset HS post bariatric surgery. Future reporting is needed to conclusively determine the role of diet in HS.
Research Synopsis:
https://pubmed.ncbi.nlm.nih.gov/31651051
Full Research Circulation PDF Google:
https://drive.google.com/file/d/1dV6WdYkI64_LtlHMHv43tsOfPTMZ9sGH/view?usp=drivesdk
Dietary Triggers & Modifications
Synopsis:
While dietary triggers have been investigated in acne and other inflammatory follicular dermatoses, there is a paucity of data on diet and hidradenitis suppurativa (HS). We sought to identify exacerbating and alleviating foods in HS patients. An anonymous survey was distributed via HS Facebook support groups and in person at HS specialty clinics. Participants were asked to select all that apply from a list to indicate foods that worsen and make HS better including sweet foods, breads and pasta, red meat, chicken, fish, canned foods, fruits, vegetables, dairy, high-fat foods, I do not know, and no. Only 12.0% (n = 89/744) identified alleviating foods while 32.6% (n = 237/728) identified HS-symptom-exacerbating foods. The most commonly reported exacerbating foods were sweets (67.9%), bread/pasta/rice (51.1%), dairy (50.6%), and high-fat foods (44.2%). The most commonly reported alleviating foods included vegetables (78.7%), fruit (56.2%), chicken (51.7%), and fish (42.7%). Further studies are required to evaluate the mechanistic links between diet and HS. HS patients may benefit from receiving dietary counseling as part of a comprehensive HS management plan.
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Mediterranean Diet
Role of Nutrition and Adherence to the Mediterranean Diet in the Multidisciplinary Approach of Hidradenitis Suppurativa:
Evaluation of Nutritional Status and Its Association With Severity of Disease
Synopsis:
Hidradenitis suppurativa (HS) is a chronic, inflammatory and debilitating skin disorder. The exacerbating factors of HS include nutrition and adiposity. We aimed to investigate the relationships between body composition and the adherence to the Mediterranean diet (MD) with the severity of HS in a sample of naive-treatment patients with HS. In this case⁻controlled, cross-sectional study, we enrolled 41 HS patients and 41 control subjects. Body composition was evaluated by a bioelectrical impedance analysis (BIA) phase-sensitive system. PREvención con DIeta MEDiterránea (PREDIMED) and the 7-day food records were used to evaluate the degree of adherence to the MD and dietary pattern, respectively. The clinical severity was assessed by using the Sartorius HS score. HS patients had a worse body composition, in particular lower phase angle (PhA) (p < 0.001), and a lower adherence to the MD than controls, in spite of no differences in energy intake between the two groups. The receiver operator characteristic (ROC) analysis showing a value of PhA of ≤ 5.7 and a PREDIMED score of ≤ 5.0 identified HS patients with the highest clinical severity of the disease. After adjusting for sex, age, body mass index (BMI), and total energy intake, the HS Sartorius score maintained negative correlations with PhA (p < 0.001), PREDIMED score, and n-3 polyunsaturated fatty acids (p = 0.005). The results of the multivariate analysis showed PhA and PREDIMED score were the major determinants of HS Sartorius score, explaining 82.0% and 30.4% of its variability, respectively (p < 0.001). Novel associations were demonstrated between PhA and the degree of adherence to the MD with the HS severity. PhA and PREDIMED score might represent possible markers of severity of HS in a clinical setting.
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Ramadan Fasting and HS
Studies on the role of diet in the management of HS are needed
Synopsis:
We systematically reviewed the literature concerning dietary interventions in HS, identifying 4 original studies. Systematic searches were performed in PubMed, Embase, and Cochrane Library using search strings: hidradenitis suppurativa OR acne inversa OR acne conglobata OR apocrine acne AND diet OR nutrition OR food OR meal OR milk OR dairy products OR plant based. One of the included articles was identified directly from references of a recent systematic review. The dietary interventions explored in the studies were a dairy-free die, brewer’s yeast exclusion, and the Mediterranean diet.
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Surgery & Yeast Exclusion Diet. Results After 6 Years
Treatment of Hidradenitis Suppurativa:
Surgery and Yeast (Saccharomyces Cerevisiae) Exclusion Diet
Results After 6 Years
Synopsis:
Background: Hidradenitis suppurativa is a complex disorder, the pathogenesis of which is still unsolved. The known association between hidradenitis suppurativa and Crohn’s disease, an autoimmune disease diagnosed with the presence of Anti-Saccharomyces cerevisiae antibodies of the IgG family, suggests that a much more complex mechanism than a simple infectious disorder is involved. The goal of this study is to report patients’ characteristics and the outcome of 6 years of a yeast (Saccharomyces cerevisiae)-exclusion diet and surgery in the treatment of hidradenitis suppurativa.
Method: We analyzed 185 patients with hidradenitis suppurativa with a self-evaluative questionnaire. Thirty-seven patients were treated in our center following our protocol. The other 148 were members of a support group for patients with hidradenitis suppurativa treated by other centers.
Results: In 80% of patients who had the onset of hidradenitis suppurativa before the age of 30, the female to male ratio was 3.34:1, 74% were active smokers, and 5% also had Crohn’s disease. In the diet group, 70% had an improvement of hidradenitis suppurativa symptomatology, 81% of whom in less than 6 months. Also, 87% of patients demonstrated an immediate recurrence of skin lesions less than a week after consuming a food containing the yeast. Immunologic testing showed intolerance to yeast, wheat, and cow’s milk in 20%, 29%, and 23% of patients, respectively.
Conclusion: The analysis confirmed the stabilization and regression of hidradenitis suppurativa with our diet, presumably by decreasing the local and systemic inflammation, leading to a less invasive operative treatment. These new findings seem to link hidradenitis suppurativa to food intolerance and gut dysbiosis.
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