Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Which food items worsen or improve hidradenitis suppurativa?

Publish date:: December 7, 2020

Key clinical point: Sweets, bread/pasta/rice, dairy, and high-fat foods in fat are likely to cause exacerbations in patients with hidradenitis suppurativa (HS).

Major finding: 32.6% of participants identified HS-symptom-exacerbating foods, whereas only 12.0% identified alleviating foods. The most commonly reported exacerbating foods were sweets (67.9%), bread/pasta/rice (51.1%), dairy (50.6%), and high-fat foods (42.2%). Alleviating foods included vegetables (78.7%), fruit (56.2%), chicken (51.7%), and fish (42.7%).

Study details: The findings are based on an anonymous survey on diet and HS distributed via HS Facebook support groups and in person at 3 North American HS specialty clinics between December 2017 and June 2019. A total of 770 people with HS (mean age, 36.5 years) participated in the survey.

Disclosures: No study sponsor was identified. VY Shi is a stock shareholder of Learn Health and has served as an advisory board member, investigator, and/or received research funding from Sanofi Genzyme, Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Menlo Therapeutics, Burt's Bees, Altus Lab, GpSkin and Skin Actives Scientific. No other disclosures were reported.

Commentary

“Patients with hidradenitis frequently inquire about the role of diet and dietary modification in HS disease severity. Yet, a lack of high-quality data on this topic limits the ability of clinicians to provide their patients with useful guidance.

In this survey study administered online through international Facebook HS support groups and at three HS specialty clinics, patients identified foods which seemed to exacerbate or alleviate HS symptoms. The findings largely mirror what has been suggested previously about the role of diet in HS, namely that dairy and simple carbohydrates may worsen symptoms. In addition, the survey revealed that foods commonly associated with the Mediterranean diet—vegetables, fruits, and fish—as well as chicken, may alleviate symptoms.

While prior work has suggested some plausible biological mechanisms to believe such observations may be valid, there is still much to be done. Survey studies by nature are limited by recall bias, and patient opinions may be shaped by information about diet disseminated via the HS community. Additionally, it may be hard to correlate ingestion of a particular food with flaring symptoms or new lesions which might appear days later. Rigorous studies establishing clear links between diet and disease activity are difficult to conduct.

That said, diet may well play an important role in HS disease activity. Absent more definitive data, clinicians may reasonably counsel their patients on the importance of eating a healthy, well-balanced diet and suggest that avoidance of dairy and simple sugars, in favor of increased fruit and vegetable intake, may be part of a holistic HS management plan. The study findings enhance our understanding of this important topic and highlight the need for rigorous mechanistic and interventional studies in the future.”