What lifestyle measures and home remedies can help manage hidradenitis suppurativa (HS) symptoms and prevent flare-ups in a patient with recurrent symptoms?

Lifestyle Modifications and Home Remedies for Hidradenitis Suppurativa

Smoking cessation is the single most important lifestyle intervention for preventing HS flare-ups, as approximately 70-75% of HS patients smoke and smoking is associated with increased disease severity, duration, and treatment failure. 1

Critical Lifestyle Interventions

Smoking Cessation (Highest Priority)

• Stop smoking immediately – this is non-negotiable for disease control 1
• Some data demonstrate an association between smoking status and HS severity, duration, and failure of treatment response 1
• Two case reports documented complete remission in women with HS after smoking cessation 1
• Smoking cessation improves HS outcomes as well as overall health 1, 2, 3

Weight Management

• Pursue substantial weight loss if overweight or obese – more than 75% of HS patients are overweight or obese 1
• Weight loss of >15% resulted in complete remission in 48.6% of patients, improvement in 20%, and no improvement in 20% after bariatric surgery 1
• Some data link higher body mass index with HS severity 1
• Obesity has an odds ratio of 33 compared to controls for developing HS 2
• Weight reduction may improve or resolve disease based on case reports and surveys 1, 4, 2, 3

Clothing and Friction Reduction

Wear Loose, Breathable Clothing

• Choose loose-fitting cotton clothing to minimize friction on affected areas 1
• Of 110 patients surveyed, 16% reported worsening from tight clothing/friction, while 11% reported relief from loose/cotton clothing 1
• Friction may stimulate epidermal hyperplasia contributing to HS lesion development, though evidence is limited to patient surveys 1
• Overall evidence supporting specific clothing recommendations is insufficient, but the intervention is low-risk 1

Personal Hygiene Practices

Antiseptic Cleansers

• Use chlorhexidine 4% wash, benzoyl peroxide wash, or zinc pyrithione daily as adjunctive skin cleansers 4, 3
• These cleansers can reduce bacterial colonization, particularly Staphylococcus aureus 4
• Apply to all affected areas during bathing 4, 3

Deodorants and Antiperspirants

• No strong evidence supports avoiding deodorants or antiperspirants 1
• HS was not linked to daily use of depilatories, deodorants, or antiperspirants in one small study 1
• A separate chart review found 6 of 11 patients reported adverse reactions to antiperspirant/deodorant use around HS onset, but recall bias is high 1
• Weak evidence limits firm recommendations regarding personal care products 1

Hair Removal

• Shaving and chemical depilatories are not contraindicated – no link exists between daily shaving and HS 1
• Two studies found HS was not linked to use of chemical depilatories 1

Dietary Modifications

Dairy Avoidance (Limited Evidence)

• Consider eliminating dairy products – 83% of 47 patients surveyed reported some improvement with dairy avoidance, though response bias likely influenced results 1
• None reported worsening with dairy elimination 1
• The effects of specific dietary restrictions remain unclear 1

Brewer's Yeast Avoidance (Very Limited Evidence)

• Consider avoiding brewer's yeast (Saccharomyces cerevisiae) – all 12 subjects in one study improved over 12 months and reported recurrence only after consuming brewer's yeast 1
• However, the effects of concurrent surgery confound these results 1

Supplements (Insufficient Evidence for Routine Use)

Zinc Supplementation

• Zinc gluconate 90 mg daily is NOT routinely recommended despite some positive data 1
• A retrospective study of 54 patients with Hurley stage I or II disease treated with zinc gluconate 90 mg daily plus topical triclosan 2% for 3 months showed improvement in mean DLQI score 1
• Another prospective study of 22 patients receiving 90 mg daily reported improvement in all patients (8 complete responses, 14 partial responses) 1
• The evidence is insufficient to support routine use 1

Vitamin D Supplementation

• Vitamin D supplementation is NOT routinely recommended 1
• Of 22 vitamin D-deficient HS patients who received supplements to achieve normal levels, 63% achieved a 20% decrease in inflammatory nodules 1
• The evidence is insufficient to support routine use 1

Wound Care for Active Lesions

Proper Dressing Management

• Use appropriate wound dressings for draining lesions to manage pus and exudate 4, 3, 5
• Proper wound care is a key part of management, particularly in patients with advanced HS 5
• Keep affected areas clean and dry 1

Pain Management

Over-the-Counter Options

• Use NSAIDs for symptomatic pain relief during flares 4, 3
• Pain management is an essential adjunctive measure for all HS patients 4, 3

Critical Pitfalls to Avoid

• Do NOT rely solely on lifestyle modifications for moderate-to-severe disease – these measures are adjunctive only and must be combined with appropriate medical therapy 4, 3
• Do NOT delay medical evaluation – early diagnosis and treatment with appropriate antibiotics or biologics prevents disease progression 2, 6
• Do NOT use cryotherapy for acute lesions due to pain from the procedure 1
• Do NOT expect supplements (zinc, vitamin D) to replace medical therapy – evidence is insufficient for routine use 1

When to Escalate Beyond Lifestyle Measures

• Seek medical treatment immediately if you have recurrent nodules, abscesses, or draining tunnels – lifestyle measures alone are insufficient for established disease 4, 2, 3
• Hurley Stage II or III disease requires systemic antibiotics or biologic therapy in addition to lifestyle modifications 4, 3
• Surgical intervention may be necessary for extensive disease with sinus tracts and scarring 1, 4, 3