Hidradenitis Suppurativa: Looking Beyond the Skin
Why hidradenitis suppurativa requires a whole-person approach
Hidradenitis suppurativa (HS) is one of the most challenging skin conditions I encounter in clinical practice. It can be painful, distressing, socially isolating and often misunderstood—not only by the public, but sometimes by healthcare professionals as well.
Many people spend years seeking answers before receiving a diagnosis. During that time, they may be told they have recurrent boils, infected hair follicles or simply sensitive skin. Meanwhile, the condition progresses and quality of life declines.
One of the most important things I want patients and practitioners to understand is that HS is much more than a skin condition.
While it presents on the skin, current research suggests HS is a chronic systemic inflammatory disease involving complex interactions between the immune system, genetics, the microbiome, metabolism and environmental factors.
Understanding these connections helps explain why a comprehensive management approach often achieves better outcomes than focusing solely on the lesions themselves.
Please note: This article is intended for educational purposes only and should not be considered medical advice. If you suspect you may have hidradenitis suppurativa, consult your GP, dermatologist or qualified healthcare practitioner for assessment and personalised treatment recommendations.
What is hidradenitis suppurativa?
Hidradenitis suppurativa is a chronic inflammatory skin condition that typically affects areas where skin rubs together, including:
- Armpits
- Groin
- Buttocks
- Under the breasts
- Perianal region
- Skin folds
It commonly begins with painful inflamed nodules that may resemble boils. These lesions can rupture, discharge and recur repeatedly in the same locations.
In more advanced cases, chronic inflammation can lead to:
- Abscess formation
- Tunnels (sinus tracts)
- Fistulas
- Significant scarring
Importantly, HS is not contagious and is not caused by poor hygiene.
Unfortunately, many people living with HS carry unnecessary shame because of this misconception.
HS is a systemic inflammatory disease
For many years HS was viewed primarily as a disorder of blocked sweat glands.
Our understanding has evolved significantly.
Current evidence suggests that HS involves dysregulation of the innate immune system, with elevated inflammatory pathways involving cytokines such as IL-17 and IL-23.
In simple terms, the immune system becomes excessively activated, driving ongoing inflammation within the skin and potentially elsewhere in the body.
This helps explain why people with HS often experience more than skin symptoms alone.
Many patients report:
- Fatigue
- Widespread pain
- Reduced wellbeing
- Mood changes
- Gastrointestinal symptoms
It also helps explain why HS is associated with a range of inflammatory and metabolic conditions.
Common comorbidities associated with HS
Research has identified increased rates of several conditions in people with HS, including:
- Inflammatory bowel disease (IBD)
- Metabolic syndrome
- Insulin resistance
- Obesity
- Polyendocrine Metabolic Ovarian Syndrome (PMOS/PCOS)
- Depression and anxiety
- Inflammatory arthritis
Not every person with HS will develop these conditions.
🚩 When to seek medical care
While HS is usually managed over the longer term, some symptoms require prompt medical assessment.
Seek medical attention if you develop:
-
Fever or chills, particularly with an active lesion
-
Rapidly increasing redness, swelling or pain
-
A rapidly enlarging or very painful abscess
-
Significant or rapidly worsening discharge or bleeding
-
Feeling suddenly or significantly unwell
If you have recurrent or persistent HS lesions, it’s also important to seek assessment from a GP or dermatologist for diagnosis and appropriate medical management.
The microbiome and the gut-skin connection
One area that continues to generate considerable interest is the relationship between HS and the microbiome.
Research suggests that both the skin microbiome and gut microbiome may differ in people living with HS.
While we still have much to learn, several mechanisms appear plausible:
- Changes in microbial diversity
- Altered immune regulation
- Increased inflammatory signalling
- Changes in skin barrier function
- Greater exposure to inflammatory bacterial products
This doesn’t mean that dysbiosis causes every case of HS.
However, when I assess patients, I am often interested in understanding whether gastrointestinal symptoms, inflammatory bowel disease, previous antibiotic exposure or other signs of microbiome disruption may be relevant contributors.
The goal is not to chase individual microbes but rather to understand the broader picture of immune and inflammatory health.
Why lifestyle factors matter
HS is not caused by lifestyle factors.
However, lifestyle factors can influence inflammation and disease severity.
Research suggests that improvements in diet quality, weight management where appropriate, physical activity and smoking cessation may reduce symptom burden for some individuals.
Areas I commonly assess include:
Diet quality
I focus on identifying dietary patterns that may contribute to inflammation while ensuring nutritional adequacy.
Rather than searching for a single “HS diet”, I typically work toward a sustainable eating pattern rich in whole foods, fibre and nutrients that support overall metabolic and immune health.
Smoking
Smoking is one of the strongest modifiable risk factors associated with HS and remains an important consideration in management.
Sleep
Poor sleep can contribute to systemic inflammation and immune dysregulation.
Stress
Stress does not cause HS, but it can influence immune function, inflammatory pathways and flare frequency.
For many people, stress management becomes an important component of a broader treatment strategy.
Want to learn more about hidradenitis suppurativa?
In this episode of Between Clinical Minds, I discuss the emerging science behind HS, including inflammation, immune dysregulation, the gut-skin connection and the clinical strategies I use to support patients. The episode also features a powerful patient perspective from clinical nutritionist Sara Dunstan and her daughter’s HS journey.
🎙️ Listen to the Episode (37 minutes)
The psychological impact of HS
The emotional burden of HS is often underestimated.
Living with painful, recurrent lesions can affect:
- Self-confidence
- Relationships
- Participation in sport and exercise
- Work attendance
- Social activities
- Mental health
Many patients live with anxiety surrounding future flares and uncertainty about when symptoms may return.
Supporting psychological wellbeing is therefore an essential part of comprehensive care.
Can HS be cured?
Currently, there is no known cure for hidradenitis suppurativa.
However, many people can achieve substantial improvements in symptom severity, flare frequency and quality of life through an individualised management plan.
Because HS is a chronic inflammatory condition, management often requires a long-term approach that combines medical treatment, lifestyle strategies and ongoing support.
The goal is not simply to suppress symptoms but to improve overall health and reduce the factors that may contribute to ongoing inflammation.
Final thoughts
Hidradenitis suppurativa is far more than a skin condition.
For many people, it represents a complex interaction between immune function, inflammation, genetics, metabolism, the microbiome and lifestyle factors.
While research continues to evolve, one thing is becoming increasingly clear: the most effective management strategies often involve looking beyond the skin.
By taking a whole-person approach and considering the broader drivers of inflammation, we can better support people living with HS and help them achieve meaningful improvements in their health and quality of life.
My Clinical Approach to HS
Every person with HS presents differently.
For this reason, I don’t use a one-size-fits-all protocol.
Instead, my approach begins with understanding the individual’s history, triggers, comorbidities and previous treatments.
Depending on the clinical picture, areas that may be explored include:
- Diet and lifestyle factors
- Metabolic health
- Inflammatory status
- Nutritional deficiencies
- Gut health and gastrointestinal symptoms
- Stress and psychological wellbeing
- Sleep quality
- Hormonal influences where relevant
Functional testing may sometimes provide useful insights, although this is always considered on a case-by-case basis and should complement, rather than replace, conventional medical assessment.
Where appropriate, I work collaboratively alongside GPs, dermatologists and other healthcare professionals involved in the patient’s care.
📞 If you’d like to learn more about how I approach HS book in a FREE 15-minute Discovery Call (**Australia only)
📚 Related resources & further reading
If you’d like to learn more about HS treatment approaches these articles may help.
Natural Treatments for hidradenitis suppurativa
An overview on diet, lifestyle, nutional supplementation and herbal medicines which may help support HS.
👉🏻 Read the blog
Research: A Survey of Australian Naturopaths' Treatment Approaches to HS
Published in the Journal of Integrative and Complmentary Medicine this 2026 survey provides foundational resarch into how Australian naturopaths treat HS.
👉🏻 Read the study
Frequently asked HS questions
How can naturopathy help with hidradenitis suppurativa?
If you have HS, you may be wondering whether there is anything you can do beyond treating individual lesions when they flare.
Naturopathic care can provide a broader look at the factors that may be contributing to inflammation and affecting your overall health. Rather than focusing only on the skin, I consider the bigger picture — including your diet, gut health, metabolic health, hormonal factors, lifestyle, stress, sleep and previous medical treatment.
The aim is to develop a practical, individualised approach that complements your medical care rather than replacing it.
Will you look at my gut health?
Gut health can be relevant when working with HS, particularly when digestive symptoms are also present.
Research has identified differences in the gut and skin microbiome in people with HS, although it is not yet clear whether these changes contribute to HS or occur as a consequence of the condition.
In practice, I don’t recommend trying to “fix your microbiome” based on a single test result. Instead, I consider your digestive symptoms, diet, bowel habits and overall health to determine whether gut-focused nutrition or other strategies may be appropriate for you.
Do I need to have gut problems for Naturopathy to help?
No. Gut symptoms aren’t essential for taking a whole-person approach to HS.
Depending on your individual situation, we may also look at factors such as nutrition, metabolic health, hormonal influences, sleep, stress, smoking, physical activity and medications or supplements you are already taking.
Not everyone needs to investigate every possible factor. The aim is to work out what is relevant for you, rather than giving you a long list of things to change.
Can naturopathy replace antibiotics, biologic medicines or dermatology treatment?
No. HS can be a serious chronic inflammatory condition, and medical treatment remains an important part of care for many people.
My role is to work alongside your GP or dermatologist where appropriate. Naturopathic care may focus on nutrition, lifestyle and other supportive strategies that can sit alongside your existing medical treatment.
If you’re already using medication, I’ll also take this into account when considering supplements or herbal medicines.
Do I need lots of supplements?
No.
My approach isn’t about sending you home with a bag full of supplements. I prefer to identify the areas where there is a reasonable clinical rationale for intervention and keep treatment as targeted as possible.
Supplements and herbal medicines may sometimes be useful therapeutic support, particularly at certain stages of care, but they
What are your qualifications?
I hold an undergraduate Bachelor of Health Science (Naturopathy) and a post graduate Master of Advanced Naturopathic Medicine. I am a professional member of the Australian Naturopathic Practitioners Association (ANPA) which requires me to hold all appropriate insurances and complete on-going professional development education to ensure my care aligns with current best practice.
How much does a consultation cost?
Consultation fees are transparent and available before booking. Fees are for consults only. Any products purchased from the dispensary are an additional cost.
The current consultation fees can be found on the Book a consult page. Naturopathy is not covered by Medicare. Some private health insurance funds offer rebates for Naturopathy. Check with your fund for details.
If you want more information before booking I also offer a free Discovery Call.
What happens during an HS naturopathy consultation?
Your first consultation is an opportunity to look at the whole picture.
We’ll discuss your HS history, including how your symptoms present, previous treatments and your experience with medical care. We’ll also talk about your diet, digestion, lifestyle, sleep, stress and any other symptoms or health concerns that may be relevant.
Where appropriate, I may also review pathology or other test results and consider whether further investigation would be useful.
From there, we’ll identify the areas where naturopathic care may be able to provide meaningful support and develop a practical plan based on your individual needs.
Is naturopathy suitable even if my HS is severe?
Naturopathy isn’t a substitute for medical management of moderate or severe HS. If you have significant, recurrent or worsening lesions, scarring, tunnels or other complications, appropriate dermatological care is important.
Naturopathic care may still have a role as complementary support, provided it is appropriate for your individual circumstances and coordinated with your medical treatment.
What if I'm not sure what's contributing to my HS?
That’s actually a common reason people seek a consultation.
There isn’t one single cause of HS, and the factors involved can differ between individuals. Rather than assuming that your HS is caused by one food, one gut imbalance or one lifestyle factor, I take the time to understand your individual history and identify the areas that are most relevant to you.
The goal isn’t to promise a cure. It’s to help you understand your health more clearly and identify practical ways to support your wellbeing alongside appropriate medical care.
Clinical review and authorship
This page has been written and reviewed by Norelle Hentschel (Master of Advanced Naturopathic Medicine) a degree-qualified naturopath.
Content is informed by traditional naturopathic principles, current nutrition and gut health research, and over a decade of clinical experience.
Last reviewed on 5 September 2026