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The millions of bacteria that live on our skin and in our guts (along with their interactions) may hold the key to treating hidradenitis suppurativa.

Researchers are increasingly turning to bacteria in our guts and on the surface of our skin for clues about autoinflammatory diseases like hidradenitis suppurativa (HS), a chronic disease that causes painful, recurring cysts, boils, and abscesses.

It makes sense when you think about it: our immune system’s defences are found in our intestinal and cutaneous (skin) microbiomes, where trillions of harmless and disease-causing microbes (not just bacteria, but also viruses, fungi, and parasites) teem, fighting for our bodies’ health.

While the skin connection to HS is almost obvious, the gut connection may appear more unusual as symptoms emerge at the groyne, armpits, between the buttocks, or inside the folds of the breasts. We went to research and our top hidradenitis suppurativa expert for answers.

Possible Bacterial Imbalance

Everyone’s microbiome comprises a diverse range of bacteria, with a healthy mix of beneficial (or neutral) microorganisms coexisting with pathogenic bacteria. However, anything—a sickness, an infection, or even antibiotics—can upset that equilibrium, resulting in dysbiosis, which means less diversity and more of the so-called “bad” bacteria wreaking havoc.

Dysbiosis may help explain what’s going on in the bowels and skin of people with chronic illnesses like HS. However, there is also the gut-skin axis to consider, which is the interaction between the microorganisms in your intestines and your skin. And this contact may be critical.

“The gut-skin axis refers to the crosstalk between the skin microbiome and the gut microbiome, as well as the disease manifestations or conditions that can occur as a result of that,” explains Dr Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics.

There has been a lot of research done on the gut microbiota of people who have inflammatory skin diseases including psoriasis and eczema. According to Dr. Adil, researchers observed significant dysbiosis in them. “That would imply that there’s something about the gut and the microbiome they have in their gut, as well as their skin,” he explains.

So, what does all of this mean for persons who have hidradenitis suppurativa (HS)? “The short answer is, we don’t know,” Dr. Adil concedes – for the time being. She goes on to say that there are theories and hints that could lead to better therapies.

Bacteria are most likely the source of HS.

Doctors are aware that bacteria play a role in hidradenitis suppurativa, but they are unsure how.

Doctors believe that hair follicles in HS patients do not work properly, leading plugs to form. Bacteria and cell debris in the plug induce the creation of a cyst, which ruptures owing to pressure and spreads deep within the skin rather than on its surface. Dr. Adil believes that the bacteria, when mixed with other components in the hair follicle, causes an inflammatory response.

In mild cases of HS, this could be a few painful boil-like nodules. As the illness worsens, the nodules join together to form even more painful tunnels beneath the skin.

Is there any evidence that disease-causing microbes are to blame for HS? When doctors swab the pus-filled lesions and nodules, they identify normal bacteria as well as staph aureus, the most dangerous of the several prevalent staphylococcal bacteria, according to the Merck Manual. Another? Antibiotics, whether topical or oral, aid many, if not all, people with HS.

This information “indicates that bacteria play a role in disease development.””But we don’t know what’s going on in that kind of interaction,” argues Dr. Adil. It’s likely that your immune system is overactive, causing the inflammatory response to the bacteria on your skin. It’s also possible that there’s a bacterial imbalance affecting your immune system. “Perhaps there is a third factor at work.” “That could be something like someone’s hair follicles, plus bacteria, plus the person’s immune system, plus hormonal factors, all of which could be involved,” he explains.

Bacterial Networks Could Help

“There was a thought that, ‘Oh, we just need to find the one bad actor,” Dr. Adil recalls from his early days studying the human microbiome. We just need to find that one horrible bug, and then we’ll be able to get rid of X problem.” Scientists now believe that networks of bacteria exist inside everyone’s gut that work together to cause diseases or maintain health.

So, if you have HS, specific strains of bacteria may be collaborating in your gut to produce proteins that cause your immune system to malfunction, explains Dr. Adil. “And when that immune dysfunction is combined with someone who is predisposed to HS, it causes the inflammatory response.” She continues by claiming that this process is to blame for both the initial outbreak and the subsequent flares.

According to Dr. Adil, there have been very few studies, notably on the gut flora in HS patients, and researchers have found no difference between HS patients and non-HS patients. Researchers have found little evidence of an imbalance or a lack of diversity. That isn’t to say it doesn’t exist; she points out that no study has ever looked at the gut flora of people with severe HS.

Anaerobic Bacteria Might Have Some Answers

While the gut microbiome has yet to reveal its secrets, scientists have observed differences in the type of bacteria on the skin of HS patients, both in lesion-filled areas and in locations where outbreaks do not occur.

According to Dr. Adil, one distinction is that there are fewer “normal” skin bacteria (which everyone has) and more anaerobic bacteria, which are bacteria that do not require (and prefer not to have) oxygen to survive. Anaerobic bacteria do not normally live on the skin’s surface; “so, if anaerobic bacteria is there, why is it there?” he wonders.

“Anaerobic bacteria could be driving inflammation in HS,” says Dr. Adil, “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 focus is that it has not followed HS patients over time to see if the type of bacteria changes during flares and periods of remission, so these findings are snapshots and small pieces of a larger puzzle as doctors try to figure out what’s going on in HS.

Better treatments are on their way.

According to Dr. Adil, the hope and goal of all those stomach and skin studies are threefold. “One approach would be to target patient therapy more precisely. The second goal is to gain a better understanding of the illness in general. “And three could be to categorise people,” she continues. If your HS develops as a blackhead-dominant disorder, for example, you may be harbouring bacteria that varies from the person with HS who has pus-oozing lesions.

Knowing this would allow doctors to give different sorts of treatment to different patients. 

“If we eventually end up targeting the gut microbiome, we might think about specific diets,” Doctor says. “I believe the sky’s the limit with HS because there is still so much we don’t understand.”

That would be a blessing for everyone with HS. Because antibiotics have side effects and microorganisms can become resistant, topical and oral medicines are required. Other alternatives include surgery and TNF-inhibitors (such as Humira), which, like biologicals, can affect a person’s immune system.

Biologics, antibiotics, and hormone therapy for HS each have their own set of adverse effects, such as affecting the immune system balance (Biologics), affecting the microbiome balance (Antibiotics), or causing hormonal imbalance (Hormone Therapy).

Ayurvedic treatment for hidradenitis suppurativa 

The goal of treatment is to restore the body’s natural balance by detoxifying it with powerful herbal remedies. 

Elite Ayurveda’s treatment for Hidradenitis Suppurativa includes balancing the Kapha and Pitta doshas as well as restoring metabolism harmony. Body detoxification, internal medications to balance doshas, and exterior applications to repair wounds are all part of the treatment.

The treatment consists of herbal mixtures generated based on individual Prakruti and Vikruti analyses. To learn more, please visit our website.

Our Prognosis –

EliteAyurveda Clinics has a panel of doctors in many medical disciplines such as endocrine, autoimmune, gynaecology, and so on under one roof. We are well-known for treating chronic and difficult-to-treat illnesses with a holistic and root-cause approach.

To learn more, please contact us.

Connect with us to obtain patient testimonials and to chat directly with our patients about their experience in having their ailment treated by us and Ayurveda in general.

Dr. Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics, reviewed the medical records. With over 15 years of experience in Neurological, Skin, and Autoimmune Disease treatment.

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