Episode 83: Hidradenitis Suppurativa (HS): The Skin Condition Nobody Is Talking About

If you've ever had a recurring boil in your armpit, groin, or under your breast and been told it's just ingrown hair or a sign of poor hygiene, this episode is for you.Dr. Sarah and Dr. Dasha are diving into hidradenitis suppurativa (HS): a chronic inflammatory skin condition that is far more common than most people realize, deeply connected to insulin resistance and immune dysfunction, and almost always misdiagnosed or dismissed.Here's what they cover:What HS actually is — a chronic inflammatory disease of the hair follicle, not an infection, not caused by poor hygiene, and absolutely not your faultThe three Hurley stages — from a single boil to interconnected tunnels and scarring, and why catching it early mattersWhere HS shows up — armpits, groin, under the breasts, buttocks — and why it's so often mistaken for ingrown hairs or shaving irritationThe root causes — immune dysregulation, insulin resistance, genetics, gut dysbiosis, and a significant metabolic component (Dr. Sarah has never seen a single case without underlying metabolic dysfunction)Food and lifestyle triggers — high insulin-demand foods, histamine-rich foods (bread, vinegar, fermented products, alcohol), smoking, and sedentary behaviorWhy exercise actually helps — and why the "sweating makes it worse" myth is causing real harmWhat treatment actually looks like — from dietary shifts and targeted supplements (zinc, vitamin D, doxycycline at low doses) to biologics and surgery for severe casesThe hormonal piece — androgens, the cycle connection, and why "estrogen dominance" is not the right explanationWhat an AWH visit looks like — from assessment and staging through to a flare plan and a maintenance planTakeaways from this episode: HS is not caused by poor hygiene — it's an immune and metabolic conditionIf you have recurring boils in classic locations AND PCOS/PMOS or insulin resistance, get screened A fasting insulin test isn't enough — a 2-hour glucose challenge reveals the real pictureLow insulin demand eating and managing metabolic health are foundational to managing HS Sweating does not make HS worse — exercise actually improves outcomes If a provider just gives you one thing and sends you home, that's a red flag — this condition requires a comprehensive plan There is hope — this condition can be brought under control with the right team📍 Resources & LinksBook with Dr. Dasha or the AWH team: advancedwomenshealth.caFollow Dr. Sarah: @drsarah_ndFollow Dr. Dasha: @dr.dashalenevaAdvanced Women's Health: @advancedwomenshealth