Physical Activity and Hidradenitis Suppurativa: A Narrative Review

Abstract

Hidradenitis suppurativa (HS) is a systemic inflammatory dermatosis characterized by follicular occlusion and a cytokine profile dominated by TNF-α and IL-17. Obesity is a primary modifiable risk factor.

The objective of this analysis is to determine whether and how physical activity modifies the clinical progression, inflammatory status, and metabolic profile of patients diagnosed with HS.

This study synthesized clinical data regarding the pathophysiology of HS, the endocrine function of adipose tissue, and the systemic effects of various physical activity intensities. Analysis focused on the correlation between BMI and Hurley staging, the impact of exercise on pro-inflammatory cytokines, and the role of mechanical factors in lesion formation.

Physical activity exerts a bidirectional effect on HS. Systemically, regular moderate exercise induces an anti-inflammatory state by reducing C-reactive protein and increasing IL-10, while weight reduction of at least 10 percent is associated with significant clinical improvement. Conversely, physical exertion may cause local exacerbations; sweat-induced maceration and mechanical friction in intertriginous zones can trigger new lesions via the Koebner phenomenon. While active patients exhibit lower Hurley stages and improved quality of life scores, approximately 60 percent of the HS population remains sedentary due to chronic pain and mechanical limitations caused by sinus tracts.

Physical activity modifies the course of HS primarily as an indirect systemic stabilizer that reduces the inflammatory burden and improves metabolic sensitivity. However, to avoid local mechanical provocation of the pilosebaceous unit, exercise regimens must be individualized, prioritizing low-friction modalities to balance systemic benefits against the risk of localized disease flares.