Hidradenitis suppurativa (HS) is a chronic condition that causes painful boils to form in skin folds.
HS is an inflammatory condition that is associated with several comorbidities. These include overweight or obesity and metabolic syndrome, a condition in which a person often has increased abdominal fat storage.
In one study from 2015, researchers found that people with HS typically had higher body fat, a larger waist, a higher body mass index (BMI), and a greater waist-to-hip ratio than those without the condition.
In this article, we look in more detail at the connection between HS and weight and explain whether weight loss can help reduce symptoms.
One of the most prominent symptoms of HS is cyst-like bumps, nodules, or abscesses on or near areas where the skin folds rub together.
Over time, a person may notice that these areas:
- last a long time
- become painful
- get bigger
- leak or ooze foul-smelling liquid or pus
- connect to other nodules through tunnels in the skin
- disappear and then reappear in the same location
- scar after they heal
Factors that can trigger an HS flare or worsen HS symptoms include:
- larger areas of skin folds or other areas of skin-to-skin contact
- skin areas where there is increased moisture and temperature
Larger areas of skin folds can cause friction, which can injure the skin and rupture hair follicles. The areas where friction and injury are more likely to occur are generally warmer and have more moisture than other areas. These factors can make them conducive to microbial growth.
Additionally, research suggests that people with overweight or obesity have higher levels of inflammation.
Some research suggests that losing weight can help improve HS symptoms.
A study of 383 people with obesity and HS who underwent bariatric surgery showed that weight loss could reduce the prevalence and severity of symptoms.
Among those who had lost weight, the number of individuals reporting HS symptoms decreased by 35%. The study also showed that there were fewer areas of boils and skin lesions in the group of people who lost weight. In addition, those who lost 15% or more of their body weight got the most relief from their HS symptoms.
Researchers believe that weight loss reduces HS symptoms because it decreases:
- microbial colonization
Some people with HS may consider weight loss surgery as a way to help them achieve a more moderate weight and improve their symptoms.
A case study of a woman with HS and obesity describes improvements to her HS symptoms within 3 months of having a laparoscopic gastric sleeve procedure. After this time, the discharge and foul odor disappeared from her lesions, and no new lesions formed. A year later, she had significant weight loss and symptom reduction.
However, while some people may see their HS symptoms lessen as a result of weight loss surgery, researchers caution that these surgeries do carry risks relating to HS.
For instance, weight loss surgery is not a guarantee that HS symptoms will decrease. A survey of online forum posts showed that only 29% of people with HS who had undergone weight loss surgery saw an improvement in symptoms. Of the survey participants, 39% reported no change in symptoms. Others reported that weight loss surgery even made their symptoms worse.
Rapid weight loss, which is common after weight loss surgery, can cause excess loose skin. The excess skin can lead to an increase in skin folds and, therefore, areas of friction, which can increase HS symptoms.
Weight loss can be challenging for anyone. If a person with HS is finding it difficult to lose weight, and diet and exercise changes are proving ineffective, weight loss surgery may be an option.
A gastric bypass leads to weight loss by restricting the amount of food that a person can consume. The surgeon will section off a very small portion of the stomach and connect it with the small intestine. These changes also cause the gut to release extra hormones that promote satiety and fullness.
A sleeve gastrectomy is less invasive than a gastric bypass. In this procedure, a surgeon will remove about 80% of the stomach and form a banana-shaped pouch from the portion of the stomach that remains. It involves a shorter hospital stay than a gastric bypass but leads to significant, lasting weight loss.
Adjustable gastric band
The adjustable gastric band is a small inflatable band. A surgeon places it around the stomach to section off the upper portion of the stomach into a small pouch and keep it separate from the rest of the stomach. This procedure is reversible and less invasive, but it still aids weight loss.
However, the adjustable gastric band may lead to a slower initial weight loss than other weight loss procedures. Those who undergo it must also follow a strict postoperative diet. This procedure has a lower rate of success and a higher chance of reoperation being necessary.
Biliopancreatic diversion with duodenal switch (BPD/DS)
During a BPD/DS, a surgeon creates a small stomach pouch by removing a portion of this organ. They then attach part of the small intestine to the pouch, meaning that food bypasses a large part of this tube.
Among the bariatric surgery options, this procedure generally causes the most significant weight loss. However, it also has a higher rate of complications and morbidity than the other procedures.
A person with HS should talk to their doctor to determine which procedure, if any, is right for them.
As with any surgical procedure, weight loss surgery carries some risks, including:
- anesthesia-related risks
- acid reflux
- stomach or bowel obstruction or perforation
- lack of weight loss
- vitamin or mineral deficiency
- internal bleeding
- injury to an organ
Additionally, people with HS may risk increasing their HS symptoms or not alleviating them.
Weight loss has many benefits, aside from improving HS symptoms.
Additional benefits of weight loss include:
- lower risk of diabetes
- improved cardiovascular health and reduced risk of heart disease
- better mobility
- less joint pain
- improvement in metabolic function
- better blood sugar control
According to the American Academy of Dermatology (AAD), when a person with HS loses just 10% of their body weight, they experience fewer flare-ups.
Evidence suggests that losing weight can improve the symptoms of hidradenitis suppurativa. It can also improve a person’s overall health. If a person finds it difficult to lose weight through lifestyle changes, they may consider weight loss surgery. A person should talk to their doctor about the best options for weight loss and HS management.