Hidradenitis suppurativa (parts1,2,3,4)
“Hidradenitis suppurativa is considered a medical mystery when viewed from the pathologic-pharmacocentric model. You know I don’t play that game.” DrV
1. Description and Medical Treatment
Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disorder characterized by excess inflammation (eg, increased cytokine and chemokine secretion) and somewhat paradoxical impairment of immune defense (decreased expression of innate immunity markers such as toll-like receptors 2, 3, 4, 7, and 9; intercellular adhesion molecule 1, etc) against microbes, especially Gram-positive bacteria.
The disease is essentially a chronic and exaggerated inflammation of the unit of hair follicles and sweat glands, or—as we like to say in the snack room—the folliculopilosebaceous unit. One might think that we would just treat this as a type of chronic severe folliculitis (hair follicle infection) but NO—we have to make it much more complicated than that.
Note that this hyperinflammatory-hypodefensive paradox is observed in various granulomatous diseases. Note also that the hyperinflammatory-hypodefensive paradox is characteristic of vitamin D deficiency—more on that later as we have data specific to HS, but if you know my work then you already know where I am going with that idea.
Medical treatment sits and spins around 1) systemic drug antibiotics, 2) topical drug antibiotics, 3) denial of the existence of nutrition, 4) expensive and repeatable office procedures such as biopsies and skin excisions, and 5) high-level “biologic” anti-inflammatory drugs that cost more per year than the average salary of the average American (which is ~USD$55,000).
In fact, when I look at the 2019 treatment protocol* recommended by the American Academy of Family Physicians, I get the impression that it is designed to maximize profit, prolong illness and minimize patient benefit.
2. Obvious need for topical antimicrobial treatment, specifically with povidone iodinOK, I will go out on a limb here and state the obvious: that any recurrent bacterial infection of the skin should be addressed with use of topical povidone iodine. There, I said it.
This post took at least 8 hours of work. This specialty post is reserved for paid subscribers and other people nice enough to buy me a coffee to support the time and effort. Yes, this post is awesome and packed with great information, but it is not personalized medical advice.
“The goal of medical therapy is to ignore nutrition and low-cost treatments in order to maximize use of expensive drugs and high-paying office procedures that have to be repeated.” Dr Alex Vasquez
3. Dose-dependent relationship between disease severity and vitamin D deficiency
Just the facts:
HS patients are commonly deficient in vitamin D.
Worse vitamin D deficiency = worse HS disease
Correcting the vitamin D deficiency = alleviation of the disease
Fact #3 above proves that the deficiency is causing/exacerbating the HS disease and not that the HS disease is causing the deficiency, although in truth the relationship is likely somewhat bidirectional.