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These affected skin areas have dense amounts of apocrine glands: small structures attached to a hair follicle that often secrete skin oils.  These apocrine and follicular structures are affected by hyperkeratosis (thickening of the outer layer of skin by a protein called keratin) which blocks the outlet of the gland, creating congestion/blockage, inflammation and a favourable environment for bacteria to thrive. 


The exact cause of HS is unknown, however it typically appears at the onset of puberty, and occurs more in women than men, suggesting some hormonal involvement.

There is a higher incidence of HS in people who smoke or who are obese, and have a family history of HS. However you can have the disease without experiencing any of this.

17% of patients with Crohns disease have HS, suggesting that autoimmune related inflammation and activity is involved in some types of HS.

Interestingly many female patients report aggravations of their HS premenstrually indicating  a hormonal relationship of their condition.



First line medical approaches are typically to relieve symptoms and include 

  • antibiotics to control infection
  • corticosteroids to control inflammation
  • biological therapy to suppress inflammation, and 
  • surgery to remove stubborn lesions.

Drug therapy in HS is generally long term, which introduces the risk of adverse events related to the medicines or techniques.  For example, gastrointestinal disturbances and vaginal candidiasis are reported with long term antibiotic therapy.

Biological therapy ( eg immunomodulators and monoclonal antibodies) are designed to help the condition by lowering inflammation which unfortunately also suppressing the immune system, leading to an increased risk of opportunistic infections. This can be unhelpful if the lesions are prone to bacterial infection.


The deleterious effect of antibiotics on human microbiome diversity is well recognised, and in turn negatively impacts immune defence as well as inflammatory modulation – both critical functions in the development of HS. 

Topical cortisone reduces inflammation at the site, however long term use of steroids is linked with contact sensitisation, dermal skin infections, topical steroid withdrawal syndrome (TSW) and thinning of the skin.  

Finally surgical treatments are employed in advanced cases of HS.  Removal of HS lesions through a procedure known as wide angle excision is an invasive procedure, involving slow healing times that employ grafting and granulation techniques.



‍In our clinic, skin practitioner Rebecca Hughes, helps patients with acne inversa address causes and factors that are contributing to their condition so they can feel well again. This starts with a comprehensive assessment of a patient's health, including:

  • Health history
  • Family history
  • Diet and lifestyle
  • Hormonal health
  • Cardiometabolic health
  • Gut health
  • Possibel drivers of inflammation

Functional testing may be suggested to help identify the factors contributing to HS and may include:

  • Assessing for risk of autoimmunity, due to the known links with autoimmune conditions like Crohns disease
  • Metabolic assessment given the association with weight gain
  • Food sensitivities, which might be a driver of autoimmunity and inflammation
  • Hormone testing where relevant
  • Nutrient status e.g. vitamin D, zinc
  • Comprehensive gut health assessment for functional markers that influence inflammation
  • Environmental toxic burden that contributes to or drives inflammation e.g. heavy metal, biotoxin susceptibility

Then, a personalised plan will be formulated, and with the support of a health coach - an expert in behaviour change - patients will implement a plan that may include:

  • Low inflammatory diet
  • Enhancing organs and systems of detoxification eg lymphatic system, liver, gall-bladder, and bowel with nutrients and herbal medicine
  • Hormone balancing
  • Stress management techniques like meditation or mindfulness
  • Smoking cessation and alcohol reduction
  • Supplemention of nutrients that either directly or indirectly lower inflammation, improve resistance to infection, rebalance hormones, enhance wound healing time, modulate the immune system eg zinc, vitamin  A, vitamin D and bioflavonoids
  • Targeted protocols to address other factors like thyroid health, digestive disorders, or toxin exposure
  • Referrals to trusted mental health care professionals 

Are you ready for a personalised, natural functional medicine treatment? Our unique model of care was designed with you in mind. Find out how here, then book a call today!

What causes eczema?

There isn’t one single cause of eczema but a range of potential contributing factors that are unique to each person. These include:


Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.

These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.

Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected. 

Food allergy and sensitivity

Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.

Compromised gut health

The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.

Nutritional deficiencies

Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).

Weather and environment

Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.


Hormones also play a role in the course of atopic dermatitis, including the stress hormone cortisol which triggers an inflammatory immune response affecting all organs of the body, including the skin.

Mould exposure

Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.

Case study

See how functional medicine is helping our patients achieve better health and richer lives.


Hidradenitis suppurativa (HS) or Acne inversa (AI) is a skin condition characterised by large, persistent abscesses or boils that appear under the skin, typically in the armpit, perianal, breast fold and genital regions. These lesions are very painful, become infected and often rupture.

Complications and associated conditions of HS include sinus tracts (tunneling wounds), fistulae (abnormal passages between organs), scarring, squamous cell carcinoma, lymphedoema, reactive arthritis,  chronic pain syndrome, Crohns disease and anaemia.  In addition to physical symptoms HS is associated with profoundly negative impacts on quality of life, mental health, social interaction and sexual function.

Whilst affecting up to 4% of people, unfortunately HS is under-diagnosed, and therefore often untreated. Sadly, patients often avoid seeking help due to feelings of embarrasment and shame.

Are you ready for a personalised, natural functional medicine treatment? Our unique model of care was designed with you in mind. Find out how, then book a call today!


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