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

Background: Dietary 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. Objective: To 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. Methods: A 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. Results: Eleven 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. A small pilot study reported clinical improvement following a very low-calorie ketogenic diet, and yeast-exclusion diets were associated with symptom improvement in small patient cohorts. Evidence from bariatric surgery cohorts suggested that malabsorptive procedures and persistent micronutrient deficiencies may be associated with worsening HS in some patients. Overall, the available studies suggest potential links between diet and HS through metabolic, inflammatory, and microbiome-related pathways, although the evidence remains limited and heterogeneous. Conclusion: Current evidence suggests that dietary habits and nutritional status may influence hidradenitis suppurativa through metabolic and inflammatory mechanisms. Although data remain heterogeneous and largely observational, promoting anti-inflammatory dietary patterns, optimizing micronutrient intake, and addressing obesity may offer supportive benefits alongside standard HS therapies. Further controlled studies are needed to establish causality.