Disordered Eating in Hidradenitis Suppurativa

Importance: Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules and abscesses that have a significant impact on quality of life. In addition to other psychological comorbidities, patients with HS often face body image issues and emotional distress that may increase the risk of maladaptive eating behaviors and disordered eating. Objective: To explore the role of disordered eating behaviors and diagnosed eating disorders among patients with HS and examine the underexplored relationship between HS and disordered eating. Evidence Review: MEDLINE, Embase, Scopus, and Web of Science were searched from inception to May 2025 for this systematic review. Eligible articles reported on eating disorders or disordered eating behaviors in patients with HS, with the references of included articles searched for additional texts. Study quality was assessed with the Newcastle-Ottawa Scale. Findings: Seven studies were identified, including 2363 patients (1666 [73.7%] female; mean age, 44.7 years). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorders were found in 3.7% of patients (79 of 2123), comprising binge-eating disorder (53 of 79 [67.1%]), anorexia nervosa (6 of 79 [7.6%]), and bulimia nervosa (7/79 [8.9%]). Disordered eating behaviors were present in 27.8% of the cohort (84 of 302), including concerns surrounding dieting, body weight, or problematic eating behaviors (27 of 84 [32.1%]); improper laxative, diet pill, or diuretic use (30 of 84 [35.7%]); food addiction (18 of 84 [21.4%]); and emotional eating (9 of 84 [10.7%]). Conclusions and Relevance: This study suggests that disordered eating may be part of the wider spectrum of psychological burden in patients with HS, highlighting the potential value of multidisciplinary care and clinical awareness to mitigate its adverse impact on treatment outcomes and quality of life. Future research is necessary to elucidate the nature and prevalence of disordered eating in people with HS compared with those with comparable demographic risk factors and in the general population.