Clinician Insights: Vitamin and Mineral Supplementation in Hidradenitis Suppurativa
Evaluating the impact on disease progression and symptom management
Key Takeaways:
Deficiencies in vitamins D, C, E, zinc, iron, and other micronutrients may contribute to the severity of hidradenitis suppurativa (HS).
Emerging research suggests that supplementation with these nutrients could help reduce inflammation and improve symptom management.
Vitamin D plays a crucial role in immune regulation, and deficiency is strongly associated with more severe HS symptoms.
Zinc is known for its anti-inflammatory and wound-healing properties and has shown promise in improving HS outcomes.
Antioxidants like vitamins C and E may help mitigate oxidative stress, which contributes to HS pathogenesis.
While supplementation appears beneficial, more large-scale clinical trials are needed to establish standardized dosing and long-term efficacy.
Like many other inflammatory skin conditions, hidradenitis suppurativa (HS) is influenced by a complex interplay of lifestyle and environmental factors. In my practice, I always counsel HS patients on the importance of dietary changes, weight management, and smoking cessation—along with targeted supplementation. After first hearing about this approach at a medical conference, my go-to recommendation has been zinc (50 mg) with copper (2 mg) twice daily, plus vitamin C (500 mg) twice daily. Anecdotally, I’ve seen great results with this combination. But what does the research say? A recent review article prompted me to take a deeper dive into the evidence. Here’s what I found:
Hidradenitis Suppurativa and Nutrient Deficiencies
HS is a chronic inflammatory skin condition characterized by painful nodules, abscesses, and draining sinus tracts, significantly affecting patients' quality of life. The condition is associated with systemic inflammation, and some studies suggest that micronutrient deficiencies may exacerbate symptoms or influence disease progression.
Vitamin D: A Key Player in HS Management
Research consistently highlights a strong association between vitamin D deficiency and HS severity. Patients with HS are significantly more likely to have lower serum vitamin D levels, and some studies report improvements in symptoms with vitamin D supplementation. Vitamin D is believed to regulate immune function and skin homeostasis, potentially reducing inflammation and lesion severity. Some pilot studies have demonstrated that vitamin D supplementation decreases the number of inflammatory nodules in HS patients.
Zinc: Anti-Inflammatory and Wound-Healing Benefits
Zinc is an essential trace element with well-documented anti-inflammatory properties. It modulates inflammatory cytokines, reduces oxidative stress, and plays a role in wound healing. Studies suggest that zinc supplementation may lead to partial or complete clinical improvement in some HS patients. However, gastrointestinal side effects are common with certain zinc formulations, and proper dosing is crucial.
Copper and Zinc: Competing Minerals, Complementary Benefits
Copper and zinc have a complex relationship in the body, as they compete for absorption in the gut. It's important to dose copper with zinc because:
Preventing Copper Deficiency – High doses of zinc can inhibit copper absorption, potentially leading to a copper deficiency. This can result in anemia, weakened immune function, and neurological issues.
Balancing Mineral Ratios – Zinc and copper work together in various enzymatic processes, including antioxidant defense and immune function. Maintaining a proper ratio (typically around 10:1 zinc to copper) helps prevent imbalances.
Avoiding Adverse Effects of Excess Zinc – Long-term high-dose zinc supplementation (often used for immune support or acne) can lower copper levels, which may contribute to problems like fatigue, nerve dysfunction, and cardiovascular issues.
For most people, dietary intake provides adequate copper, but when supplementing with high doses of zinc (>40 mg/day), adding 1-2 mg of copper is generally recommended to maintain balance.
The Role of Antioxidants: Vitamin C and Vitamin E
Oxidative stress is believed to contribute to HS pathogenesis. Vitamin C and vitamin E are potent antioxidants that help neutralize free radicals and support skin healing. Although there is limited research specifically on HS, these vitamins may offer additional benefits in managing inflammation and reducing tissue damage.
Iron, Vitamin A, and Vitamin B12 Considerations
Iron deficiency anemia is frequently observed in HS patients, and monitoring hemoglobin levels may be useful in tracking disease severity.
Vitamin A plays a role in skin cell turnover and immune function. Retinoids, which are vitamin A derivatives, are sometimes used in HS treatment.
Vitamin B12 levels should be assessed in patients with HS who have risk factors such as obesity, cardiovascular disease, or alcohol use disorder.
Future Research and Recommendations
While the existing data suggests a potential role for vitamin and mineral supplementation in HS management, more research is needed. Large-scale, randomized controlled trials are necessary to determine optimal dosing, safety, and long-term efficacy. Until then, clinicians may consider screening HS patients for deficiencies in vitamin D, zinc, iron, and other key nutrients, offering supplementation where appropriate while monitoring for safety and effectiveness.
Resources
Herrick, G., Kakarla, S., Frasier, K., Mukarram, M., Rodriguez, E., Dragovic, M., Vinagolu-Baur, J. and Welp, H., 2025. Evaluating the impact of high-dose vitamin D3, vitamin C, vitamin E, and zinc supplementation on inflammatory cytokines, lesion severity, and symptom management in hidradenitis suppurativa. International Journal of Research, 11(2), p.199.
Lackner, L., Zyriax, B.C. and Stephan, B., 2024. To what Extent does Vitamin D and its Serum Levels Influence the Severity of Hidradenitis Suppurativa: A Literature Review. Acta dermato-venereologica, 104, p.40321.
Weir, S.A., Roman, B., Jiminez, V., Burns, M., Sanyi, A., Elewski, B. and Mayo, T., 2023. Hidradenitis Suppurativa and Five Key vitamins and minerals. Skin Appendage Disorders, 9(3), pp.153-159.
Osredkar, J. and Sustar, N., 2011. Copper and zinc, biological role and significance of copper/zinc imbalance. J Clinic Toxicol s, 3(2161), p.0495.