Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can be painful, persistent and incredibly frustrating to live with. It can involve recurrent lumps, abscesses, drainage, scarring and inflammation, often around the armpits, groin, buttocks, breasts and other areas where skin rubs together.
For many people, HS isn’t simply a skin problem. It can affect confidence, movement, sleep, relationships, mental wellbeing and everyday life.
As a nutritionist, herbalist and naturopath, I take a whole-person approach to supporting people with HS. This doesn’t mean promising a “natural cure” or suggesting that food and herbs can replace medical treatment. Rather, it means looking at the wider picture and asking: what factors might be supporting inflammation, metabolic health, nutritional status and the body’s ability to cope with this chronic condition?
Understanding HS as more than a skin condition
Hidradenitis suppurativa involves inflammation around the hair follicle which also involves the immune system. The exact causes are complex and can involve genetics, hormones, immune regulation, metabolic health and environmental factors. This is why I don’t believe there is one universal “HS diet”. Two people with HS can have completely different experiences, nutritional needs and triggers.
Start with the foundations
Before reaching for supplements or herbal remedies, I believe it is important to establish the basics.
A nourishing diet can provide the body with the energy, protein, fibre, vitamins, minerals and essential fats it needs to function well.
A Mediterranean-style pattern is a useful starting point for many people, this type of diet is known for its anti-inflammatory effects and for most people is easy to incorporate. This might include:
· Plenty of colourful fruits and vegetables
· Beans, lentils and other pulses
· Wholegrains where tolerated
· A variety of different nuts and seeds
· Extra Virgin Olive Oil and other healthy fats
· Fish, particularly oily fish
· Adequate protein with every meal
· Herbs and spices
· Plenty of fluids
At the same time, it can be helpful to reduce reliance on foods that are high in refined carbohydrates, added sugars and highly processed ingredients. These type of foods can drive inflammation through various mechanisms.
This isn’t about creating a “perfect” diet. It’s about gradually increasing the nutritional quality of what is already being eaten. When you increase healthier foods then you tend to naturally reduce the unhealthier ones because you’re not able to eat it all and balancing your meals correctly can also create more satiety and reduce cravings.
Blood sugar and inflammation
One area I often explore with clients is blood-sugar regulation. Diets that are consistently high in sugary drinks, sweets, refined carbohydrates and highly processed foods can make it more difficult to maintain stable blood glucose and may contribute to poorer metabolic health.
There is also interest in the relationship between insulin signalling and HS, although the research is still developing.
Rather than recommending extreme low-carbohydrate diets, a more sustainable approach might be to:
· Choose wholegrain carbohydrates over highly refined versions
· Pair carbohydrates with protein, fibre and healthy fats to stabilise glucose levels
· Include plenty of vegetables, fibre also helps to balance blood glucose
· Reduce sugary drinks
· Limit frequent high-sugar snacks, there are plenty of healthier swaps that can still satisfy a sweet tooth without spiking blood sugar levels
· Eat in a way that supports steady energy throughout the day, blood sugar and energy levels are tightly connected
Small changes can be much more achievable than another restrictive diet.
Could dairy be a trigger?
Dairy is frequently discussed in relation to HS. Some research has suggested a possible relationship between dairy consumption and HS in certain people, but the evidence isn’t strong enough to say that everyone with HS should avoid dairy. This is where an individual approach becomes important. If someone notices a consistent relationship between a particular food and their symptoms, we can investigate it rather than immediately removing half of their diet. A short, structured elimination followed by reintroduction may sometimes help identify whether a particular food is genuinely relevant. If dairy is removed, nutritional replacements need to be considered—particularly calcium, iodine, protein and vitamin B12 depending on the individual’s overall diet.
Supporting the gut
The gut and immune system are closely connected, and the gut microbiome is an interesting area of ongoing research in inflammatory conditions. That doesn’t mean that “leaky gut” is the explanation for HS, nor does it mean that everyone with HS needs an expensive probiotic programme. Instead, I prefer to focus on the fundamentals of gut-friendly nutrition by providing the healthy gut bacteria what they need for their survival, because when we feed up the healthy microbiome that are naturally resident in our guts we increase their numbers which in turn supports our systemic health. Some gut bacteria also produce anti-inflammatory compounds which contributes towards reducing inflammation systemically (not just locally in the gut).
Herbal medicine: where might it fit?
In my opinion herbal medicine can be an integral part of a personalised naturopathic approach and supports a healthy nutrition plan. Rather than giving everyone with HS a standard list of anti-inflammatory herbs, I would consider the individual’s constitution, medications, health history, nutritional status and specific goals.
Herbal approaches may be used to support areas such as digestion, stress, sleep or general wellbeing. However, evidence specifically supporting individual herbs as treatments for HS remains limited. In my opinion, this is because there isn’t ‘a herb’ for HS, it doesn’t work like that. Herbalist will look at the terrain of the client, what that means is that through a detailed consultation they will have many clues about the state of the internal body and potentially which systems are under stress and need support. Herbs are then selected to support that clients particular terrain, examples might include supporting the lymphatic system so it’s able to more effectively clear wastes, balance immunity, reduce inflammation, support the liver detoxification pathways. There are many herbs that have been used traditionally to help clear skin conditions and they work best when combined together to create a synergy of actions to support both the condition and the terrain of the client.
Supplements: less is sometimes more
It can be tempting to build a large supplement programme when someone has a chronic inflammatory condition. I prefer a more targeted approach. Depending on the individual, it may be appropriate to discuss nutritional status and potential deficiencies such as vitamin D, zinc, iron, B12 or folate with their healthcare professional. Testing, where appropriate, is generally preferable to guessing.
Some studies have explored vitamin D and zinc in people with HS, but this does not mean that everyone with HS needs high-dose supplementation. Supplements should be reviewed regularly rather than taken indefinitely without a clear purpose, otherwise you risk creating imbalance in the body.
Weight and HS
HS is not simply caused by being overweight, and people of all body sizes can develop the condition. However, research has found an association between HS and obesity, and weight loss may improve symptoms for some people who are overweight. If weight management is appropriate for an individual, I believe the conversation should be about health, nourishment and sustainable habits, aggressive dieting isn’t the answer.
Don’t underestimate stress and sleep
HS can itself be stressful. Pain, uncertainty about when the next flare will occur, concerns about smell or drainage, and embarrassment about visible lesions can all take an emotional toll.
Stress doesn’t mean that HS is “all in your head.” It is a genuine inflammatory disease that can become very stressful to live with. Supporting the nervous system is still a valuable part of my approach.
Listen to your own body—but keep a critical eye
One of the most useful things someone with HS can do is become curious about their own patterns.
A simple diary can record:
· Foods and drinks
· Menstrual cycle, where relevant
· Stress
· Sleep patterns
· Exercise
· Skin symptoms and flare-ups
· Medication
· Supplements
Over time, patterns may emerge. But it’s important not to assume that every association is causal. HS naturally fluctuates, and a flare may occur after eating a particular food simply because the two events happened at the same time.
A naturopathic approach isn’t about treating the disease with one “magic” remedy
Perhaps the biggest misconception about natural medicine is that there must be one hidden cause that, once discovered, will make everything disappear. Chronic inflammatory conditions are rarely that simple.
My approach is much more about asking questions:
Are you nutritionally well nourished?
Are you eating enough protein and fibre?
Could your diet be improved without becoming restrictive?
Are there signs of nutrient deficiency?
How is your blood sugar regulation and metabolic health?
How are you sleeping?
What is your stress load?
Are there foods you genuinely seem to react to?
Could medication or supplements be interacting?
And importantly:
Are you receiving appropriate medical treatment for your HS?
Working alongside conventional medicine
I believe strongly that nutrition, herbal medicine and naturopathy can sit alongside conventional healthcare.
HS can be a serious condition, and moderate-to-severe disease may require dermatological treatment such as prescription medication.
Natural approaches shouldn’t be used to encourage someone to stop effective treatment.
Instead, the goal is to build a supportive foundation around the person, with the aim of bringing the HS more under control.
My approach in practice
I have worked with HS and seen huge improvements, everyone’s root cause is slightly different, so my approach with diet and herbs is different for each client. From my experience, herbal medicine has supported clients with boils/cysts that have solidified and become unable to drain, through to reduction in size and frequency which in turn has reduced the intensity of pain. Diet and herbal medicine has the potential to improve the quality of life for many people suffering with this painful condition. It’s not a quick fix, this is a chronic condition for most people and does require time and patience to see results, there is also no guarantee that everyone will have the same outcome.
Your skin is part of you—but it isn’t the whole of you. Supporting the person behind the condition is just as important. As Hippocrates famously said “It is more important to know what sort of person has a disease than to know what sort of disease a person has”.
If you’re suffering with HS and would like a free 15 minute discovery call to see how I can help, or would like to book a consultation then click here.
Written by Tina Prajapat DipCNM, mANP, rGNC – Registered Nutritional Therapist, Herbalist and Naturopath supporting chronic health conditions using using nutrition, herbal medicine and lifestyle approaches.
This article is for general education and isn’t intended to diagnose, treat or cure hidradenitis suppurativa. Herbal medicines and supplements can interact with medicines and may not be suitable for everyone. Anyone with HS should discuss diagnosis and treatment with an appropriate healthcare professional.
https://pmc.ncbi.nlm.nih.gov/articles/PMC13222998
https://pubmed.ncbi.nlm.nih.gov/31502868
