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Functional Interventions For Hidradenitis Suppurativa: A Case Report

Hidradenitis Suppurativa (HS),  also known as acne inversa, is a inflammatory skin condition thought to be autoimmune in nature. Typically the bumps will occur under the armpits, inside the legs and under the breasts. It has been suggested that the underlying causes of HS range anywhere from surgeries, bacterial infections, clogged follicular ducts and even genetic triggers (Scala et al. 2019). It is estimated that between two and five percent of americans suffer with this skin condition (Ardon et al. 2019). The importance of understanding potential root causes of this condition have big implications, considering the only option in the conventional model of care are antibiotics, and or immune suppressants.

Case Presentation:

The patient is a 54 year old female who presents with two half inch boils on the inside of her right leg. The boils have tracks that run approximately one inch distally. She is a successful executive who works out four times a week, eats a whole food paleolithic diet, and overall, has a superior self care regimen. The patient started to notice the painful bumps when she was 16 years old. She states they come and go and cannot identify any pattern or trigger. The patient’s blood chemistry is excellent. All her inflammatory markers such as CRP-hs, fibrinogen and sedimentation rate were within normal ranges. The patient’s thyroid, urinalysis, comprehensive metabolic panel, and salivary hormone panels were also normal. The only other marker in her labs that may be of note is that her red blood cell zinc were below lab ranges. This was further clarified with a positive zinc taste test. She does have a history of Helicobacter pylori infection, that according to her has not been previously treated. The patient has had two surgeries to remove the cysts that developed under the skin, unfortunately they were ultimately unsuccessful considering the recurrence.

Timeline of treatment:

Consultation:  6/4/18

Prescribed supplements:

• Zinc tapering up based on tolerance until the patient reached 90mg daily
• NAC – one serving TID
• Resveratrol and turmeric – 250mg of each TID
• Low-dose Naltrexone – 1.5mg increasing weekly until 4.5mg
• Essential oil blend of lavender, tea tree, bergamot, cedarwood and frankincense – applied topically BID
• ADEK (emulsified) – once daily

Original MYMOP

• Patient listed pain at a 6/10 with 10 being the highest. This was related to her ability to put tight clothes on.

Consultation:  7/4/18

Prescribed supplements:

• Supplement prescription continued as before

MYMOP

• Patient listed pain at a 4/10 with 10 being the highest. This was related to her ability to put tight clothes on.

Consultation:  9/4/19

Prescribed supplements:

• Supplement prescription continued as before

MYMOP

• Patient listed pain at a 1/10 with 10 being the highest. This was related to her ability to put tight clothes on.

Diagnostic focus and assessment

There are some positive studies revealing zinc therapy as a potential treatment for HS. Considering the patients low RBC zinc levels it seems logical to embark on supplemental zinc (Poveda et al. 2018).  Considering the positive results with biological immunosuppressant drugs and the logical notion HS is an autoimmune skin condition we decided to do a trial course of Low-dose naltrexone (LDN).  LDN is a drug that regulates opioid receptors in the brain thereby enhancing the production of TH-3 cells. TH-3 cells are immune cells that balance and coordinate immune function. Not surprisingly patients on LDN have seen tremendous results when managing various autoimmune conditions (Lee and Elston 2018). All other choices such as NAC, ADEK also enhance the production of TH-3 cells whilst resveratrol and curcumin suppress TH-17 cells which are immune cells that direct the breakdown of tissues in autoimmunity. The essential oil use is targeted locally to heal the tissue and prevent bacterial infections when the patients follicles are blocked. The MYMOP assessment was chosen to monitor the impact of her HS between diagnostic screens.

Follow up and outcomes

The patient stated she was not very compliant with the essential oils. She predicts missing one serving daily. All other supplements and prescriptions were taken as directed. Considering her MYMOP score improved substantially we can make the assumption that one or the combination of therapies listed are addressing a root issue for her HS. The patient is very happy considering she has not had relief like this in 18 years.

Discussion:

Further research clearly needs to be done on oral and cream based administration of zinc, along with the supplemental and pharmacological approach to regulating immune function for HS patients. The therapies utilized for this patient are considerably more cost effective versus the current recommendation of Humira. According to drugwatch.com, Humira costs on average, 50,000 dollars a year. The key takeaway from this case report is that HS is clearly a either due to a mineral deficiency and or combination thereof with a autoimmune condition.