The millions of bacteria present on our skin and inside our guts (and their interactions) could hold the secret to treating hidradenitis suppurativa.
Researchers have been increasingly looking to bacteria—both in our guts and on the surface of our skin—for hints regarding autoinflammatory illnesses such as hidradenitis suppurativa (HS), a chronic disease that causes painful, recurring cysts, boils, and abscesses.
When you think about it, it makes sense: our immune system’s defences are found in our intestinal and cutaneous (that’s skin to you and me) microbiomes, where trillions of harmless and disease-causing microbes (not just bacteria, but also viruses, fungi, and parasites) teem, fighting for our bodies’ health.
However, while the skin connection to HS is almost clear, as symptoms manifest near the groin, armpits, between the buttocks, or within the folds of the breasts, the gut connection may appear more strange. For solutions, we turned to the research and our top hidradenitis suppurativa expert.
Potential Bacterial Imbalance
Everyone’s microbiome contains a variety of bacteria, with a balance of beneficial (or neutral bacteria) coexisting alongside disease-causing germs. But anything—a disease, an infection, even antibiotics—can throw that balance off, resulting in dysbiosis, which means less diversity and more of the so-called “bad” bacteria remaining to wreak havoc.
Dysbiosis may help explain what’s going on in persons with chronic conditions like HS’s guts and skin. However, there is also the relationship between the bacteria in your intestines and your skin to consider, which scientists refer to as the gut-skin axis. And this interaction could be crucial.
“Gut-skin axis refers to the crosstalk between the microbiome of the skin and the microbiome of the gut, and the disease manifestations or conditions that can occur in relation to that,” explains Dr Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics.
A lot of research have been conducted on the gut microbiota of persons suffering from inflammatory skin illnesses such as psoriasis and eczema. Researchers discovered substantial dysbiosis in them, according to Dr. Adil. “That would imply that there’s something about the gut and the microbiome they have in their gut, as well as their skin,” he says.
So, what does it all mean for people suffering with hidradenitis suppurativa (HS)? “The short answer is, we don’t know,” Dr. Adil admits—yet. She adds that there are theories and clues that may lead to better treatments.
Bacteria are a likely cause of HS.
Doctors know microorganisms are involved in hidradenitis suppurativa, but they don’t know how.
Doctors believe that the hair follicles in HS patients do not function properly, causing the follicles to produce plugs. The contents of the plug—bacteria and cell debris—cause the formation of a cyst, which ruptures due to pressure and spreads deep within the skin rather than on its surface. According to Dr. Adil, the bacteria, combined with the other components in the hair follicle, cause an inflammatory response.
In moderate cases of HS, this may consist of a few painful boil-like nodules. When the condition progresses, the nodules unite to produce even more painful tunnels beneath the skin.
One sign that disease-causing microorganisms are to blame for HS? According to the Merck Manual, when doctors swab the pus-filled sores and nodules, they find normal bacteria as well as staph aureus, the most hazardous of the several common staphylococcal bacteria. Another? Many, if not all, persons with HS benefit from antibiotics, whether topical or oral.
This information “suggests that the bacteria play a role in the disease’s development.” But we don’t know what’s going on in that kind of interaction,” Dr. Adil explains. It’s possible that you have an overactive immune system, which causes the inflammatory response to the microorganisms on your skin. Or it could be that there is a bacterial imbalance that especially reacts with your immune system. “Perhaps there is a third factor at work.” “That could be someone’s hair follicles, plus bacteria, plus the person’s immune system, plus hormonal factors, all of which could be involved,” he says.
Bacterial Networks Could Play a Role
“There was a thought that, ‘Oh, we just need to find the one bad actor,” says Dr. Adil, in the early days of investigating the human microbiome. We need to locate the one nasty bug, and once we do, we’ll be able to eliminate X condition.” Scientists now believe that inside everyone’s gut exist networks of bacteria that collaborate to induce diseases or sustain health.
So, if you have HS, you may have specific strains of bacteria working together in your gut to make proteins that cause your immune system to malfunction, adds Dr. Adil. “And when that immune dysfunction is combined with someone who is predisposed to HS, it causes the inflammatory response.” She goes on to say that this mechanism is to blame for both the initial epidemic and the repeated flares.
To date, there have been relatively few studies particularly analysing the gut flora in HS patients, and researchers haven’t identified any difference between HS patients and non-HS patients, notes Dr. Adil. Researchers haven’t discovered much of an imbalance or a lack of diversity. That doesn’t imply it doesn’t exist; she points out that no study has looked at the gut flora of persons with severe HS to date.
Anaerobic Bacteria Could Provide Some Answers
While the gut microbiome has yet to reveal its secrets, scientists have discovered variations in the sort of bacteria on the skin of HS patients, both in lesion-filled areas and in places without outbreaks.
One difference is that there are fewer “normal” skin bacteria (which everyone has) and more anaerobic bacteria, which are bacteria that don’t require (and prefer not to have) oxygen to exist, according to Dr. Adil. Typically, anaerobic bacteria do not dwell on the skin’s surface; “so, if anaerobic bacteria is there, why is it there?” he wonders.
According to Dr. Adil, “Anaerobic bacteria could be driving inflammation in HS because those bacteria do not exist in abundance on the surface of the skin in otherwise healthy people who do not have HS.” “The other theory is that they’re just secondary actors who don’t play a role in causing or driving HS but are the result of the primary process, whatever that might be.”
One disadvantage of this research emphasis is that it has not followed HS patients over time to determine if the type of bacteria changes throughout flares and periods of remission, so these findings are snapshots and small pieces of the broader puzzle as doctors try to figure out what’s going on in HS.
Better Treatments Are on the Way and exist.
According to Dr. Adil, the hope and goal of all those investigations on the stomach and skin are threefold. “One would be to make patient therapy more targeted. The second goal would be to have a better knowledge of the condition in general. “And three could be to categorize people,” she adds. For example, if your HS manifests as a blackhead-dominant disorder, you may be harboring bacteria that differs from the person with HS who has lesions that ooze pus.
Knowing this would enable doctors to administer different types of treatment for each patient.
“If we eventually end up targeting the gut microbiome, we might think about specific diets,” Dr. Charrow explains. “I believe the sky’s the limit with HS because there is still so much we don’t understand.”
That would be a godsend for anyone suffering from HS. You can’t put people on antibiotics for years (they have adverse effects and germs can get resistant), so topical and oral medications are a must. Surgery and TNF-inhibitors (like Humira) are other options which carry their own problems like with biologicals disrupting a person’s immune system.
Medicines for HS involving biologics, antibiotics or hormone therapy come with their own set of side effects like impacting the immune system balance (Biologics), or impacting the microbiome balance (antibiotics), or leading to hormonal imbalance (hormone therapy)
In Ayurveda, hidradenitis suppurativa Treatment is to restore the body’s natural equilibrium by detoxifying it with potent herbal therapies.
The treatment for Hidradenitis Suppurativa at Elite Ayurveda comprises balancing the Kapha and Pitta doshas, as well as providing harmony to the metabolism. The treatment comprises body detoxification, internal drugs to balance doshas, and external applications to heal scars.
The treatment involves combinations of herbs created based on individual Prakruti and Vikruti analysis. Visit our website to know more
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Medically reviewed by Dr Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics. With over 15 years of experience in treating Neurological, Skin & Autoimmune Diseases.
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