Hormones, Blood Sugar, & Hidradenitis Suppurativa (HS)
Intro
Hidradenitis suppurativa (HS), also known as acne inversa, is described as a skin condition that causes deep and painful lumps under the skin, usually found in the armpits or groin, according to the American Academy of Dermatology. HS is a little-known condition, and the cause of HS is still yet to be fully understood. However, there are some pieces of research out there that help us understand what is taking place in HS and how hormones & blood sugar could be contributing to the condition. In this blog, I will share those pieces of research to help us connect the dots and understand more about HS, blood sugar, & hormones.
WhY does Hidradenitis suppurativa happen?
The jury is still out on exactly why HS happens. But, there is literature that has been looking at different parts of HS, such as what is happening within lesions and what could be contributing to the development of HS lesions. What we know from research is that:
Hair follicles in sweat-gland bearing skin get plugged in HS
Bacterial infections could be a risk factor in the development of HS, since staphylococci & anaerobic bacteria are commonly found in HS lesions
There is a connection between androgens and HS
There is a connection between metabolic syndrome and insulin resistance with HS
Androgens & HS
There is a hypothesis that androgens could be one of the driving factors of HS. Androgens are sex hormones produced in the ovaries that are responsible for:
Puberty - stimulates hair growth in the pubic region and underarms
Reproductive health
Bone health
Estrogen production
& more
HS has been linked to androgens since androgen also stimulate sweat glands and enhance keratin production in skin, which promotes plugging of the follicle. Additionally, oral anti-androgen medications have been shown to improve HS, specifically spironolactone reducing number of lesions and pain.
Metabolic syndrome, insulin resistance, & HS
HS has also been linked to insulin resistance & metabolic syndrome. Research indicates that there is a significant relationship between HS and metabolic syndrome, such as obesity, high triglycerides, low HDL, and diabetes. However, the reason why that happens is still yet to be fully understood. Furthermore, insulin resistance is seen more in those with HS. And, research suggests that those with HS could have undiagnosed diabetes and pre-diabetes since those diagnosed with HS can have labs indicating elevated blood sugar.
We also know that there is a connection between androgens and insulin resistance in polycystic ovarian syndrome (PCOS), which has been shown to lead to acne, facial and body hair growth, and other symptoms of high androgens. We also end up seeing some of these high-androgen symptoms in those with HS, further suggesting that there could be a connection between androgens, insulin resistance, and HS. But again, it is still yet to be fully understood what happens in HS since there is literature that suggests that low sex hormone binding globulin (SHBG) would be the main culprit to some symptoms of HS, since SHBG could be important in proper skin function. And, the effect of low SHBG is high androgens.
To tie everything together, a published case report that revealed a combination of metformin (an anti-diabetic medication), liraglutide (an anti-diabetic medication), hormonal birth control, dapsone (an antibiotic), and finasteride (an anti-androgenic medication) greatly diminished HS flare intensity and duration. This multi-pronged approach that looks at hormones, blood sugar, and bacteria suggests that there could be a connection between all of those factors.
Takeaways & Summary
Hidradenitis suppurativa is a little-known skin condition, and we are yet to fully understand what causes it. As a licensed naturopathic doctor (ND), I see chronic skin issues as a manifestation of some sort of internal imbalance, and treating internal imbalances eventually lead to optimal skin health.
At the moment, scientific literature has made connections between bacterial infections and HS; androgens and HS; metabolic syndrome and HS; and insulin resistance and HS. From connecting the dots together we can postulate that there is a connection between all of them, but science has yet to fully explain how and why HS happens. All of this preliminary science does make me hopeful that we will better understand how internal imbalances contribute to HS sooner than later.
Due to the connections that science has seen with HS, it may be worth people’s while to speak to their doctor about:
Blood sugar levels: Blood glucose, hemoglobin A1c, and more
Androgen levels: Testosterone, dihydrotestosterone, sex hormone binding globulin, and more
Cholesterol levels: Total cholesterol, triglycerides, and more