Dietary patterns, metabolic pathways and metainflammation in hidradenitis suppurativa: a systematic review

BackgroundDietary factors have been suggested to influence inflammatory skin diseases; however, their role in the pathogenesis and clinical course of hidradenitis suppurativa (HS) remains insufficiently understood. Increasing evidence suggests that HS is a systemic immunometabolic disease characterized by chronic low-grade inflammation and metabolic comorbidities such as obesity, insulin resistance, and metabolic syndrome.

Dietary patterns may therefore influence HS activity through metabolic and inflammatory pathways.ObjectiveTo systematically evaluate available evidence on dietary patterns, nutritional interventions, and micronutrient status in hidradenitis suppurativa and to assess their associations with disease onset, disease severity, and underlying metabolic and inflammatory mechanisms.MethodsA systematic search was conducted in PubMed/Medline for studies published between 1985 and 2026, following PRISMA guidelines. Eligible study types included observational studies, interventional trials, and case-control or cross-sectional studies investigating dietary exposures or nutritional interventions in HS.

Reference lists were screened for additional records.ResultsEleven studies met the inclusion criteria. Across observational cohorts, lower adherence to Mediterranean-style dietary patterns, higher glycaemic dietary patterns, and micronutrient deficiencies, particularly vitamin D and zinc, were generally associated with greater HS disease severity.

Interventional evidence was limited.