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Hidradenitis suppurativa through a functional and Eastern medicine lens
Hidradenitis suppurativa is not just a skin issue. It is a chronic inflammatory condition marked by painful recurrent nodules, abscesses, tunneling, and scarring, and it often makes more sense when viewed through immune function, hormones, the gut-skin axis, stress physiology, and the body's broader inflammatory terrain.
A functional medicine framework for HS
Hidradenitis suppurativa, also called acne inversa, is commonly described in dermatology as a chronic inflammatory follicular disorder. From a functional medicine perspective, that description is true but incomplete. HS usually reflects a more complex interaction between immune dysregulation, hormones, metabolic influences, gut health, environmental stressors, and lifestyle burden.
The point is not to deny the skin findings. It is to ask what internal terrain is helping repeated inflammation, pain, and slow healing persist.
HS is seen on the skin, but it is rarely explained by the skin alone.
Common drivers and aggravators
The newsletter highlighted several recurring factors that deserve attention in HS:
- Immune dysregulation: HS behaves like an autoinflammatory condition, with inappropriate immune activation around hair follicles.
- Gut-skin axis disruption: dysbiosis, intestinal permeability, and broader inflammatory gut patterns may amplify skin inflammation.
- Hormonal influences: sex-hormone shifts and insulin resistance can affect flare tendency and inflammatory signaling.
- Chronic inflammation: dietary triggers, infections, metabolic burden, and environmental factors may all feed the inflammatory baseline.
- Nutrient deficiencies: vitamin D, zinc, and other nutrient gaps can weaken resilience, immune regulation, and skin repair.
- Lifestyle burden: stress, poor sleep, smoking, friction, weight burden in some cases, and insufficient recovery all matter.
This is one of the reasons HS can feel so frustrating. Even when the lesions are local, the contributors are often systemic.
How I think about treatment
The functional medicine approach is individualized and should work alongside good dermatologic care rather than pretending to replace it.
| Treatment layer | What it often includes |
|---|---|
| Assessment | History, family pattern, diet, stress load, environmental exposures, and targeted labs for inflammation, hormones, gut status, and nutrients |
| Dietary work | Anti-inflammatory eating, reduction of likely trigger foods, lower glycemic burden, and sometimes dairy, refined sugar, yeast, or processed-food reduction |
| Gut restoration | Strategies for dysbiosis and intestinal permeability, including microbiome work, glutamine, and broader gut-healing support when indicated |
| Inflammation and hormones | Curcumin, omega-3s, insulin-sensitivity support such as berberine when appropriate, and broader metabolic or endocrine support |
| Lifestyle support | Sleep repair, stress management, smoking cessation, gentle exercise, and reducing friction and aggravating clothing patterns |
The goal is not perfection. It is reducing flare intensity, improving healing, lowering inflammatory burden, and making the condition more manageable over time.
The Chinese medicine view
Chinese medicine sees HS as a systemic pattern that happens to express through the skin. The newsletter emphasized several recurrent pattern ideas:
- Damp-Heat: redness, swelling, pus, heaviness, and the recurrent inflammatory nature of the lesions
- Blood Stasis: chronic pain, hard nodules, impaired healing, and scarring
- Toxic Heat: more intense inflammatory flares and abscess formation
- Zang-Fu disharmony: especially involving the Liver, Spleen, and Lungs
- Qi stagnation: the contribution of emotional stress, frustration, and impaired circulation of Qi and Blood
Treatment can include acupuncture, individualized herbal medicine, dietary therapy aimed at reducing Heat and Dampness, and supportive practices such as Qi Gong, sleep regulation, and avoiding friction on affected areas.
Why the integrative model matters
HS is exactly the sort of condition where a one-size-fits-all approach tends to disappoint. Some people need more dermatologic escalation. Some need deeper metabolic or hormonal work. Some need the gut piece addressed more seriously. Some are being pushed repeatedly by stress, sleep loss, or smoking. Most need a combination.
The strength of an integrative model is that it allows the local skin problem and the wider body story to be treated as part of the same condition. That usually leads to a more realistic and sustainable strategy than either lens alone.