Hidradenitis Suppurativa (HS) is an autoinflammatory condition causing painful, recurring boils in the areas of your body that have sweat glands. There is no cure, but treatments are available that can manage symptoms. Various skin growth types may occur, including abscesses, nodules, and sinus tracts, which are channels that form between the abscesses and the surface of your skin. A referral to a dermatologist is very common, and popular medications to treat HS include antibiotics, biologics, metformin, and birth control pills. 

[signup]

CC: Hidradenitis Suppurativa

Sam was a 30-year-old female diagnosed with HS 10 years ago at 20 years old. Both her mother and sister also suffered from this condition. It was located under her arms bilaterally and her groin. Areas would get very inflamed, swollen, and she would experience drainage in those areas. She had tried many medications, such as spironolactone, Stelara, and Humira, but nothing helped. She was currently on the hormonal IUD. Symptoms had worsened over the last five years, and Sam was desperate for help. 

Sam was also diagnosed with Hashimoto's thyroiditis, Psoriasis, and headaches. She often struggled with anxiety, fatigue, depression, poor sleep, and congestion and always felt bloated. 

Historically, she had taken many antibiotics as she felt she always had ear infections as a kid and sinus infections as an adult. Her diet resembled the Standard American Diet (SAD), which contained sugar cereals, pizza, spaghetti, subs, fast foods, etc. Sam reported high levels of stress as she worked in the medical field and took care of her family. 

Initial Lab Work

NMR Blood Panel

Lab Analysis 

Sam's initial labs showed a lot of valuable information. She had nutrient deficiencies. She was low in vitamin D and omega fatty acids and had a functionally low ferritin level, which indicated low iron storage. Low levels could indicate a lack of dietary intake or absorption. Vitamin D, although called a vitamin, acts as a hormone and is very important for energy, hormone support, etc. Low omegas can lead to higher levels of inflammation and are essential in gut, brain, joint, hormone, and liver health. 

Sam's labs showed abnormal lab values that indicated an underlying cardio-metabolic aspect to health concerns. Labs showed hyperlipidemia, prediabetes, and high insulin levels. 

Thyroid hormones were still within normal levels. However, the patient had high TPO levels, confirming Hashimoto thyroiditis. Sam had high levels of RT3, which is a concern as the body was converting too much FT4 into RT3 instead of FT3, which is commonly linked to stress. In addition, although she had normal/low levels of testosterone, she did have high levels of androstenedione, a more potent form of testosterone. 

Sam showed a positive CIC, which indicates levels of candida were found in the body.

By testing GlycA, it was indicated that the patient had systemic inflammation. C3a showed that her immune system was not functioning optimally, which was supported by a positive antinuclear antibody (ANA). Immunoglobulin A and CD57 were low, again indicating immune system abnormalities. 

Interventions

Sam started the anti-candida diet and continued it for three months. In addition, she took caprylic acid (800 mg 2-3x/day), grapefruit seed extract (500 mg 2x/day), and uva ursi (1,000 mg 2x/day) to kill the candida. A broad spectrum selection of herbs was used as the candida was not cultured. In addition, she was given omega fatty acids (2 g daily), vitamin D3/K2 (5,000 IU daily), and magnesium glycinate (500 mg daily) to support nutrient deficiencies. Sam also started a blend of adaptogenic herbs, Nuadapt from OrthoMolecular, that contained a combination of Bacopa, Ashwagandha, Rhodiola, L-theanine, phosphatidylserine, and Eleuthero to support adrenal health. She was recommended to switch to a copper IUD in case hormones were playing a role in her symptoms, which she successfully did. 

Follow Up 3 Months Later

NMR Panel- Did not rerun

*NMR panel and HbA1C panel were not tested since these follow-up labs were only three months after the initial lab work. They were both tested six months later, and both tests were improved. 

At the three-month follow-up, the patient reported feeling much better. She had much less muscle tension, and her TMJ pain was gone. Her current HS flares were less inflamed and were no longer oozing. She only had a few new lesions pop up. Overall, it was a 50% improvement. Headaches were 100% gone, energy was 60% better, rated 8/10 (10-best), anxiety and depression were 50% better, and she had even noticed increased libido. Gastrointestinal symptoms were 100% gone. She has daily bowel movements, no bloating, and no nasal congestion.  

At this time, Sam discontinued the candida supplements and started taking probiotics. She started Biotic Daily T and Akkermansia. She also began GI Core (glutamine, zinc, vitamin A, and various demulcent herbs) for 60 days. This was done to support gut integrity and to address treating leaky gut. At this time, she added a supplement to continue to support inflammation called "The Extinguisher," which contained a mixture of perilla, Curcuma longa, quercetin, and resveratrol. She was able to add foods back into her diet and was instructed to monitor any flare-ups. This led her to discover that eggs were a huge trigger for her, which she ate often. She also remained gluten and dairy free.

Six months later, Sam returned for a follow-up. She was doing really well and reported that her HS symptoms were 75% better overall. Her labs continued to improve, particularly her immune markers. She also had laser hair removal under her arms, which helped decrease irritation with shaving. She was thrilled with her progress. 

[signup]

Summary

Hidradenitis Suppurativa (HS) is a multifactorial condition meaning there are likely many "root causes" and many treatment options for both allopathic and functional medicine practitioners. In this case, it's still not 100% understood what the cause of Sam's HS was. But it was likely a combination of gut dysfunction, inflammation, autoimmunity, metabolic issues, and hormones. This highlights the importance that in functional medicine, it is important not to just treat the condition but treat the person with the condition.