Dietary Intervention: An Essential Part of the Management of Patients Affected by Hidradenitis Suppurativa

Dear Editor,We have read with great interest the article by Dempsey et al.[1] (2019) who carried out a cross-sectional survey on dietary alterations made by patients affected by hidradenitis suppurativa(HS). Their study highlights how avoidance of particular foods isa common management strategy attempted by HS patients [1].In our opinion dietary patterns may have an important role inthe management of HS, and the patients should be informed byexperts about the most appropriate dietary plan for their clinicalstatus. In line with our recent study, we suggest evaluation of individual nutritional status as an essential part in the management ofHS patients [2]. In fact, in HS patients, the clinical severity (HSSartorius score) was negatively and statistically significantly associated with both phase angle (PhA) values and adherence to theMediterranean diet (MD) [2].The PhA is a bioelectrical impedance analysis parameter identified as a prognostic marker of both morbidity and mortality inchronic inflammatory states [3]. The parameter is a sign of cellularintegrity and of water distribution in body fluids [4, 5]. PhA valuesare lower in a substantial group of inflammatory diseases, including also skin conditions such as psoriasis and HS [2, 6, 7].The MD is a well-recognized nutritional tool that affects thesystemic inflammatory balance and has long-lasting hormeticeffects [8]. Previous studies have already underlined its role inthe multidisciplinary management of other inflammatory cutaneous diseases. In 2018, Phan et al. [9] demonstrated how thisdietary regimen can slow the progression of psoriasis, and it isadvisable in pregnant women as it potentially decreases the riskof atopy in their offspring [10]. Compared to the control group,HS patients showed different dietary habits tending to a proinflammatory status characterized by a lower intake of complex carbohydrate, monounsaturated fatty acids, and n–3 polyunsaturated fatty acids, and a higher consumption of saturated fattyacid and n–6 polyunsaturated fatty acids [2]. Moreover, low adherers to the MD had a statistically significantly higher score inthe HS Sartorius scale [2].In addition, it has been previously shown that HS patients havea significantly higher prevalence of insulin resistance. We recentlyanalysed homoeostasis model assessment of insulin resistance(HOMA-IR) in HS patients and healthy subjects with patients having higher values (p = 0.023). Moreover, we assessed the rate ofglucose and insulin secretion after the oral glucose tolerance test.HS patients showed a significant difference regarding the insulinbut not the glucose rate with respect to healthy subjects. HS subjects affected by insulin resistance showed a correlation with disease severity as well as with the glucose rate and BMI [11].Therefore, dermatologists and nutritionists should have a multidisciplinary approach in HS patients in order to inform themabout the appropriate diet plan, guiding their dietary habits andpromoting a higher intake of foods with anti-inflammatory effectsas in the MD.In conclusion, in agreement with the study of Dempsey et al.[1], we underline once again the role of dietary patterns in themanagement of HS patients, focusing in particular on bioelectricalimpedance analysis parameters (PhA) and MD diet adherence asa potential tool in the therapeutic intervention and prognosticevaluation of HS.