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HS and Metabolic Syndrome: Understanding the Connection

Medically reviewed by Zeba Faroqui, M.D.
Written by Maureen McNulty
Posted on August 8, 2023

Some people with hidradenitis suppurativa (HS) develop comorbidities — multiple health conditions that occur at the same time. A common comorbidity of HS is metabolic syndrome (MetS), a cluster of conditions including high blood pressure and high blood sugar levels that can increase your chances of developing serious health issues.

MetS is very common, affecting about one-third of adults in the U.S. However, research suggests that people with HS may be two to four times more likely to develop MetS compared to the general population. This, in turn, increases their risk for more serious conditions like cardiovascular disease or diabetes.

Some members of myHSteam have written about their experiences with HS and metabolic syndrome. “I also have insulin resistance and metabolic syndrome, and several other health problems,” wrote one member.

If you have been diagnosed with HS, also called acne inversa, you may want to ask your doctor about your risk of developing MetS. Likewise, if you already have MetS, you may want to watch out for skin issues.

What Is Metabolic Syndrome?

Your body converts food and oxygen into energy through a process known as metabolism. The process is affected by factors such as your age, genetics, diet, and level of physical activity. It’s also controlled by molecules in your body such as insulin — a hormone that tells cells throughout your body to absorb sugar from your blood to be used as energy.

MetS occurs when metabolic processes don’t work properly. Your body stops responding to insulin like it should — known as insulin resistance — which leads to inflammation and affects the health of your heart and blood vessels. You may be diagnosed with MetS if you have at least three of the following signs:

  • Hypertension (high blood pressure)
  • Hyperglycemia (raised blood glucose levels)
  • Increased levels of triglycerides (fats) in the blood
  • Low levels of high-density lipoprotein (HDL) or “good” cholesterol
  • Abdominal obesity — Carrying a higher level of fat around your waistline compared with other parts of your body

The more of these conditions you develop, the greater your chances of developing other serious problems. MetS can lead to health issues like heart disease, stroke, liver damage, kidney problems, and sleep apnea. It can also cause type 2 diabetes mellitus, another common comorbidity for those with HS.

The Relationship Between HS and MetS

Health experts don’t entirely understand the connection between HS and MetS — or even if one necessarily causes the other.

HS leads to ongoing inflammation within the body. It can cause abnormalities in levels of certain molecules that can affect your metabolism. Other inflammatory skin diseases, such as psoriasis, are also known to trigger MetS.

This chronic inflammation may increase your risk of having several of the individual components found in metabolic syndrome. One study found that, compared to the general population, people with HS were:

  • 71 percent more likely to be obese
  • 41 percent more likely to have diabetes
  • 19 percent more likely to have high blood pressure
  • 14 percent more likely to have high levels of fat in the blood

Other studies have reported an even greater risk based on disease severity. Researchers in Denmark found that people who were hospitalized for HS were nearly four times more likely to have MetS compared to those without HS.

Some people even notice patterns between certain metabolic factors and HS flares. “One thing I have learned is that when my blood sugars are higher, it affects my HS outbreaks,” said a myHSteam member.

Overall, though researchers have found associations between HS and MetS, they aren’t sure whether the inflammation associated with HS is a trigger for MetS or vice versa.

Risk Factors for HS and MetS

HS and MetS have some risk factors in common. While not everyone with these risk factors will develop these conditions, people with these characteristics have a greater chance of developing either condition compared to the general population.

Risk factors include:

  • Being obese or overweight, clinically measured based on a person’s body mass index (BMI), which calculates the ratio of a person’s height to their weight
  • Smoking cigarettes
  • Having a family history of the conditions
  • Being female — In general, HS is more common among females than males, according to Mayo Clinic. “In older adults, women have a higher risk of metabolic syndrome than men,” according to the National Heart, Lung, and Blood Institute.

Some people may develop both HS and MetS because they have risk factors that can lead to both conditions.

Lifestyle Changes To Prevent MetS

If you’re living with HS, adopting certain habits may help reduce your risk of MetS. These healthy habits may include the following:

  • Eat more whole grains, vegetables, and fruits, or follow a heart-healthy diet such as Dietary Approaches to Stop Hypertension (or DASH).
  • Consume less saturated fat and salt.
  • Aim for 30 minutes of physical activity most days of the week.
  • Get seven to nine hours of sleep per night.
  • Quit smoking.
  • Reduce your stress levels with strategies like meditating or practicing breathing exercises.

It’s always a good idea to talk to your doctor before making any major changes to your lifestyle. Your doctor can help ensure that you aren’t cutting important nutrients out of your diet, and they can recommend exercises that will be safe for your health.

Watching Out for Health Changes

If you’re worried about your risk of MetS or HS, it can help to get regular physical exams and look out for symptoms.

While living with HS, you may want to ask your dermatology or primary care provider about getting screened for metabolic syndrome. This condition doesn’t always cause symptoms, but your doctor can determine whether you have MetS through basic tests such as measuring your blood pressure, blood sugar levels, and cholesterol levels.

If you have MetS, you may want to keep an eye out for HS symptoms, which may include:

  • Swelling, burning, itching, or discomfort in a region of your skin (commonly the underarms or groin area)
  • Painful lesions (areas of damage) or nodules (small lumps) that form in the affected skin areas
  • Abscesses (large bumps or spots that join together and fill with fluid)
  • Tiny black spots
  • Bumps that leak pus or blood
  • Scarring in areas that used to have lumps or abscesses

Tell your doctor about any new skin changes or consult with a dermatologist.

Treating MetS and HS

If you are diagnosed with both MetS and HS, you will need to make sure to properly manage your health. In some cases, the same strategies may help improve both disorders.

MetS can often be lessened or reversed using the same lifestyle changes that help prevent the condition. Improving your diet, physical activity levels, and sleep may help eliminate MetS and prevent additional issues such as heart attacks.

Making dietary changes may help improve HS severity. A diabetes drug that helps control blood sugar levels called metformin (sold as Fortamet, Glucophage, and other brands) can also help improve HS.

You may also need to work with your health care team to find additional treatments that work for you. Your doctor may suggest medications or even surgery if lifestyle changes don’t help treat MetS. Additionally, HS treatment plans typically include medications like antibiotics, steroids, retinoids, biologics, or hormonal therapy, as well as laser treatments or surgery.

Talk to your doctor if you feel like your current treatments aren’t helping to control your symptoms or boosting your quality of life.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 34,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Are you living with hidradenitis suppurativa? Has your doctor talked to you about metabolic syndrome? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on August 8, 2023
    All updates must be accompanied by text or a picture.

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    Zeba Faroqui, M.D. earned her medical degree from the SUNY Downstate College of Medicine. Learn more about her here
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here

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