Glucose metabolism disorders in hidradenitis suppurativa: Current evidence and future directions

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin condition. Emerging data suggest its link to metabolic comorbidities such as diabetes mellitus and metabolic syndrome, with overlapping pathophysiological mechanisms. Recent evidence highlights the potential use of antidiabetic medications, particularly metformin and glucagon-like peptide-1 (GLP-1) receptor agonists, in managing HS. Metformin, a first-line medication for type 2 diabetes, exerts anti-inflammatory, anti-fibrotic, and anti-angiogenic effects in addition to its glucose-lowering properties. Similarly, GLP-1 receptor agonists, widely used for glycemic control and weight management, have been shown to reduce inflammation and help control HS, particularly in patients with concurrent diabetes. This review critically examines the literature and investigates the potential epidemiological and molecular bidirectional links between glucose metabolism disorders and HS. The authors review studies and case reports that describe the successful use of antidiabetic medications in treating HS. Integrating metformin and GLP-1 receptor agonists represents a novel therapeutic option for patients with HS, especially those with concurrent metabolic comorbidities. Further, well-designed research and clinical trials are necessary to establish efficacy, optimal dosing, and patient selection criteria. This review also highlights the importance of a multidisciplinary approach to managing patients with HS.