Study: HS Linked to Hyperglycemia and Altered Amino Acid Metabolism in Plasma

Key Takeaways

• A new analysis of 72 patients with moderate-to-severe hidradenitis suppurativa (HS) suggested systemic metabolic alterations were consistently observed compared vs. healthy controls.

• Patients demonstrated hyperglycemia, elevated lactate and pyruvate, increased branched-chain amino acids (BCAAs), reduced branched-chain keto acids (BCKAs), and elevated succinate levels.

• Metabolic profiles showed minimal separation between moderate and severe HS, suggesting dysregulation presence across advanced disease stages.

New research in the Archives of Dermatological Research shows consistent metabolic alterations in patients with moderate-to-severe hidradenitis suppurativa (HS, particiularly regarding energy and amino acid metabolism, that appeared largely independent of disease severity.

Researchers analyzed plasma samples from 72 adults with HS (IHS4 ≥4) and 40 healthy controls using nuclear magnetic resonance spectroscopy. Patients were stratified as moderate (IHS4 4–9) or severe (IHS4 ≥10). 

Compared with controls, patients with HS exhibited mild hyperglycemia and elevated lactate and pyruvate levels without increased ketone bodies, a pattern the authors described as resembling nonketotic acidosis. Increases in circulating BCAAs (leucine, isoleucine, valine) were observed; their corresponding BCKAs were reduced. Additional findings included elevated succinate and aromatic amino acids (phenylalanine, tyrosine) and reduced citrate and histidine.

Monte Carlo cross-validated random forest classification differentiated HS from controls with an area under the curve (AUC) of 0.92 and out-of-bag error of 0.11. However, discrimination between moderate and severe HS was limited (AUC 0.603), suggesting that systemic metabolic dysregulation is a feature of moderate-to-severe HS rather than tightly linked to lesion burden.

The authors cited the exploratory design, lack of patients with mild disease, and potential confounding by obesity and smoking as study limitations.

“These findings indicate that HS is associated with systemic metabolic changes, while the extent of clinical manifestations likely depends on additional factors such as comorbidities and lifestyle," the authors wrote. "Potential clinical implications include dietary management of hyperglycemia and obesity, which are already part of standard care.”

Source: Vorcakova K, et al. Archives of Dermatological Research. 2026. doi:10.1007/s00403-025-04514-2