The Facts About Weight and Hidradenitis Suppurativa (HS)

by Jodi Helmer Health Writer

It can feel difficult to feel comfortable in your own skin—literally and figuratively—when you have hidradenitis suppurativa (HS), an auto-inflammatory disorder that causes painful boils and skin abscesses that sometimes emit a foul-smelling pus. According to the Cleveland Clinic, this chronic condition affects between 1% and 4% of the U.S. population and can first appear as early as puberty. Some people with HS find exercising painful to do, which can lead to unwanted weight gain—in turn, worsening symptoms. Here’s all we know about the HS-obesity connection.

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Obesity Is a Top Risk Factor—but It’s Not the Only One

Excess weight is a major risk factor for HS—though it doesn’t cause HS, and it’s not the only one. In fact, some people with HS are slender. Age and biological sex both factor in—this condition is most frequently diagnosed in women between 18 and 29, according to the Mayo Clinic. Smoking cigarettes can also increase your odds of developing HS. And, for some people, having dysfunctional sweat glands can play a role: A recent study shows how the production of dermcidin, an antimicrobial protein, can be dysregulated in HS, impairing the healing of skin lesions.

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Family History Should Also Be Considered

And, while being overweight is often associated with acne inversa (which HS is also called), developing this condition may have as much to do with your family’s genetic history, says Simon Thomsen M.D., a professor at Bispebjerg Hospital in Denmark. Research shows that a mutation of the gene responsible for the division of hair follicles and other skin cells may be partially to blame for triggering symptoms. “There are several common genes and each one adds a little increased risk” for HS, he explains, adding that obesity, which often precedes HS by 5 to 10 years, ratchets up the risk.

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Being Overweight Weight Can Worsen Flares

Still, having a BMI of 30 or above is definitely a cause for concern when it comes to HS. Compared to the general population, those living with this condition are 17 times more likely to be obese, according to 2020 research in SKIN: The Journal of Cutaneous Medicine. Obesity can also make it harder to get the disease under control, adds Victoria Shanmugam M.D., professor of medicine at the George Washington University in Washington, D.C. “A greater body mass index contributes to hormonal imbalances, as well as the increased skin friction, making the disease worse,” she explains.

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More Skin Folds Increase Friction

Additional skin folds from excess weight, commonly found in the upper body, may be the reason why obesity and HS are so often linked. Clogged sweat glands can lead to painful nodules, boil-like lumps, blackheads, and cysts developing, and, in later stages, channels may form beneath the skin in the armpits and groin, under the breasts, and on the buttocks and inner thighs. Abscesses can eventually break open, releasing an unpleasant odor. To add insult to injury, this can cause permanent scarring.

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The Skin’s Bacterial Balance May Be Off

Then there are the hot, humid areas between folds that create a breeding ground for bacteria, which may trigger an HS outbreak or make the chronic skin condition worse. “In the armpit and groin, we have a very intricate balance between [good] bacteria and foreign pathogens,” Dr. Thomsen explains. “The beneficial bacteria stave off bad bacteria but, when we have a humid environment with inflammation and friction, it leads to an imbalance that promotes bacterial growth.” Antibiotics that control bacteria are often used to treat HS. Losing weight minimizes excess skin, giving bacteria fewer places to take hold.

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Extra Weight Feeds Inflammation

Similar to other skin diseases such as psoriasis and eczema, where chronic inflammation causes the immune system to create skin changes at the cellular level, inflammation also appears to play a role in HS, says Dr.Thomsen. Obesity triggers chronic low-grade inflammation that can make symptoms of HS worse, he says, citing research from 2019 that connects greater inflammation with more severe disease outcomes. “We tend to think this chronic overweight condition is associated with low-grade systemic inflammation that leads to inflammatory changes in the skin and promotes these abscesses,” he adds.

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Lower Weight Can Lead to Fewer Flares

A 2020 study showed that overweight children who lost weight before entering puberty lowered their risk of developing HS later on. In adults, losing at least 15% of body weight is associated with significant improvements in HS symptoms. While the lesions can make exercise painful, putting in the effort to lose weight can have a significant positive impact on the disease. “HS is a disease in which consistency of exercise is more important than speed,” Dr. Shanmugam says. “Start small and increase your exercise capacity slowly to build a routine you can stick with.”

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Working Out With HS Can Be a Challenge

It might be tempting to skip a workout to avoid skin-fold friction and clogged pores from sweat, but that could lead to more weight gain and worsening symptoms. Instead, wear form-fitting workout clothes made from moisture-wicking fabrics to prevent your skin from rubbing together, and to keep problematic sweat at bay. A simple outfit change like this may make exercising more comfortable and even possible, says Ben Kaffenberger, M.D., associate professor of dermatology at The Ohio State University.

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Start Slowly, Consider Swimming, and Ask for Help if You Need It

Set small goals. To start, aim to lose just 5% of your body weight, and see how you feel. If you’re in a flare and even brisk walking is hard, let your body heal. Once the pain improves, put those sneakers on and try again. Or, try swimming some laps. “Water workouts are very good,” says Dr. Kaffenberger, because H2O lubricates the skin and minimizes friction. If you need extra support, get help from weight loss apps like Noom or Weight Watchers. As you drop extra pounds, you may see an improvement to your HS symptoms—and feel better than ever in your own skin.

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Other Kinds of Self-Care Are Key, Too

Losing weight shouldn’t be your only focus. Your doctor may also recommend medications to manage symptoms and, possibly, surgery to remove inflamed nodules, lesions or damaged tissue. Your diet is also important, Dr. Kaffenberger says. Studies have found that avoiding or limiting dairy, sugar, simple carbs, nightshade plants like tomato and eggplant, as well as bread, fermented cheese, black tea, and beer, can help reduce HS flares. Experimenting with a Paleo or autoinflammatory diet may also help. “Whether the diet truly is anti-inflammatory or whether it just results in weight loss, either way it could be beneficial,” he adds.

Jodi Helmer
Meet Our Writer
Jodi Helmer

Jodi Helmer is a North Carolina-based journalist who writes about health, fitness and nutrition topics ranging from depression and sleep to workouts and diet trends. Her work has appeared in publications such as AARP, WebMD, Woman’s Day, Shape, Health, Family Circle and MyFitnessPal.