GLP-1 Medicines and Hidradenitis Suppurativa: What the Cohort Studies and Patient Surveys Show

Can a GLP-1 medicine help hidradenitis suppurativa? The early research on GLP-1 and hidradenitis suppurativa leans hopeful. A 2026 systematic review found that 60% of patients on a GLP-1 receptor agonist improved by at least one Hurley stage. But almost all of that evidence comes from people already taking semaglutide, tirzepatide or liraglutide for diabetes or weight, and no completed placebo-controlled trial has tested the drugs for HS itself.

Hidradenitis suppurativa, or HS, is a chronic inflammatory skin disease that causes painful lumps and draining tunnels, most often in the armpits, groin and buttocks. HS affects around 1% of adults, according to the Danish registry team led by Nielsen, and it travels with obesity, diabetes and heart disease. That overlap is why so many people with HS end up on a GLP-1 for another reason, and why dermatologists started watching what happened to their skin.

This article covers what the cohort studies, systematic reviews and patient surveys report about flares, pain, quality of life, mood and weight, where the evidence is weak, and what is still unknown about lower doses.

Why is hidradenitis suppurativa linked to weight and blood sugar?

Elzawawi and colleagues, International Wound Journal, 2024

Hidradenitis suppurativa clusters with metabolic disease more tightly than most skin conditions. Elzawawi and colleagues pooled 23 studies covering 29,562,087 patients and found people with HS had higher odds of obesity (OR 2.48), type 2 diabetes (OR 2.78) and smoking (OR 3.10), and that HS was more common in women (OR 2.34).

An odds ratio of 2.48 means the odds of obesity were roughly two and a half times higher in the HS groups than in controls. These are associations, not proof that weight causes HS. Friction and moisture in skin folds, insulin resistance and the low-grade inflammation that comes with excess fat tissue are the usual proposed links.

The heterogeneity in this meta-analysis was very high, which is common when registry data and clinic samples are pooled. The direction of the result is consistent, though, and it explains why weight management features in most HS care plans. For background on how inflammation markers behave on these drugs, see our article on GLP-1s, inflammation and CRP.

How often do people with HS end up on a GLP-1?

Nielsen and colleagues, JEADV, 2026

More often and sooner than comparable groups. Nielsen and colleagues followed 12,581 Danish adults with HS, 9824 with psoriasis and 12,581 background controls from 2000 to 2022. During follow-up, 8.2% of the HS group started a GLP-1 receptor agonist, compared with 5.7% of the psoriasis group and 3.2% of controls.

People with HS also started sooner. The mean time from the index date to GLP-1 initiation was 8.88 years in the HS group, against 10.1 years for psoriasis and 10.2 years for controls. Cardiometabolic and psychiatric conditions piled up in every group over that time, so the people starting a GLP-1 typically carried a heavy burden of metabolic disease.

The most telling result came next. In the 2 years after starting a GLP-1, HS patients used fewer antibiotics and had fewer HS-related surgical procedures. But matched HS patients who never started a GLP-1 showed similar reductions, and the difference between the two groups was not statistically significant. The authors concluded that further studies are needed to know whether GLP-1 medicines directly improve HS disease activity.

What do the systematic reviews show about GLP-1s and HS severity?

Visan 2026, Kassira 2026 and Krajewski 2024

The reviews report consistent improvement with a thin evidence base. Visan and colleagues, working from St Vincent's University Hospital in Dublin, identified 19 studies with 67,568 patients. In the pooled analysis, 60% of patients improved in Hurley stage (95% CI 52-67), and the Dermatology Life Quality Index improved by a mean of 3.83 points.

Metabolic and inflammatory markers moved too. Mean C-reactive protein fell by 1.35 mg/L and HbA1c by 0.39%. The large real-world cohorts in the review showed fewer antibiotic and corticosteroid prescriptions and fewer hospitalizations, while results for biologic use, surgery and cardiovascular outcomes were mixed.

The Visan review is careful about what this means. The authors call the evidence limited and heterogeneous, and state that the relative contribution of weight-dependent and weight-independent effects cannot be determined. They also call for prospective studies and controlled trials before GLP-1 medicines can be placed in HS management.

Two other reviews agree on direction and caution. Kassira and Carley, writing in Cutis in 2026, found only three publications that met their inclusion criteria and described GLP-1s as a possible adjunct, especially in people with obesity and metabolic syndrome. A 2024 review of 25 studies by Krajewski and colleagues in the Journal of Clinical Medicine reported weight and inflammation reductions on liraglutide and semaglutide, and proposed that the drugs damp TNF-alpha, IL-17 and NF-kB signaling. That pathway work is a mechanism hypothesis, not a clinical outcome.

What do people with HS report after starting a GLP-1?

Gupta and colleagues, JAAD International, 2025

About two in three report some improvement, and one in three notice no change. A University of Pennsylvania team sent a survey to 128 HS patients on an active GLP-1 prescription. Twenty-eight completed it and 22 were analyzed. Most were women (90.9%), with an average age of 45.

The respondents were on semaglutide (40.9%), tirzepatide (36.4%), dulaglutide (18.2%) or liraglutide (4.5%), for an average of 17 months. None had been prescribed the drug for HS. Most (77.3%) reported weight loss, averaging 31 pounds, and the authors found no association between treatment duration and change in HS-specific health.

Overall, 68.2% reported improved HS-specific health and 31.8% reported no change. The improvements were spread out: 27.3% said minimally improved, 22.7% much improved and 18.2% very much improved. Respondents most often reported fewer new lesions (66.7%), fewer flares (61.9%) and less drainage (61.9%), and 59.1% said they would recommend a GLP-1 to other HS patients.

The authors list the limits plainly: a small sample, no clinician assessment, a high nonresponse rate and possible recall bias. People who felt better may have been more likely to answer. Treat these figures as patient experience, not as an efficacy rate.

Is the HS benefit only from losing weight?

The open question in every review

Nobody can say yet. The Visan review saw clinical benefit despite a modest mean BMI change of 2.64 kg/m2, which some readers take as a hint that the drugs do more than shrink fat tissue. The authors themselves stopped short of that conclusion, because none of the included studies was designed to separate the two.

Weight loss on its own is not a guaranteed fix either. Garcovich and colleagues reviewed 178 HS patients at an Italian clinic and found 12 who developed HS after bariatric surgery. Ten of them first developed skin suppuration after weight loss from malabsorptive procedures, and the group had multiple micronutrient deficiencies, with zinc significantly lower than in typical HS patients. That is a small surgical series, and nothing similar has been reported with GLP-1 weight loss, but it is a reminder that nutrition matters while the scale is falling.

For anyone eating much less on a GLP-1, our guide to micronutrient gaps on a GLP-1 covers which nutrients tend to run low, and our article on GLP-1 medicines after bariatric surgery covers the surgical overlap.

Do GLP-1 medicines affect heart and mortality risk in people with HS?

Brouer and colleagues, Frontiers in Medicine, 2026

In one large health-records study, GLP-1 users with HS had markedly fewer deaths and cardiovascular events. Brouer and colleagues used the US TriNetX network to compare adults with HS plus type 2 diabetes or obesity. 8,564 had taken a GLP-1 receptor agonist or tirzepatide for at least a year, and 6,299 had taken other diabetes or weight medicines. After propensity matching, the GLP-1 group had lower all-cause mortality (HR 0.24) and fewer major adverse cardiovascular events (HR 0.61) over 2 years.

The same study found lower hazard ratios for depression (0.78), suicidal ideation (0.38) and substance use disorder (0.58). Rheumatologic and chronic inflammatory outcomes were similar between groups. The GLP-1 group had higher risks of hyperlipidemia (HR 1.25), fatty liver disease, or MASLD (HR 1.37), and nausea or vomiting (HR 1.31).

A mortality hazard ratio as low as 0.24 is larger than randomized cardiovascular trials have shown for these drugs in general populations, which suggests that healthier or better-insured patients may have been more likely to get a GLP-1. Matching reduces that bias but cannot remove it. A 2026 JAMA Dermatology research letter by Jastrzab-Miskiewicz and colleagues also examined mortality, cardiovascular events and systemic complications in HS patients on GLP-1s; its full results were not publicly available when this article was written.

Can a GLP-1 affect mood in people with HS?

Shrestha and colleagues, Skin Appendage Disorders, 2026

The two HS-specific studies disagree, so the honest answer is uncertain. HS carries a high psychiatric burden on its own, and Shrestha and colleagues at Mayo Clinic looked at this directly in the NIH All of Us program. They compared 77 adults with HS who started a GLP-1 receptor agonist with 233 who started metformin.

At 12 months, a new psychiatric diagnosis had been recorded in 61.3% of GLP-1 users and 51.1% of metformin users, a risk ratio of 1.20 (95% CI 0.95-1.52). The hazard ratio was 1.26 (95% CI 0.90-1.78), and the gap opened mostly within the first 90 days. Because the confidence intervals cross 1, the increase was not statistically significant, and the authors call the finding hypothesis-generating.

Set beside the TriNetX result for depression (HR 0.78), the picture is mixed, and both studies are observational. Anyone with HS and a history of depression or anxiety who starts a GLP-1 should tell their prescriber about mood changes early. Our article on GLP-1 medicines and mood risk covers what the FDA and EMA reviews found in broader populations.

Does microdosing a GLP-1 help hidradenitis suppurativa?

What the evidence can and cannot support

That has not been studied. Every study in this article describes people on standard prescriptions for type 2 diabetes or weight management, and none reports results by dose. There is no data on whether a low or microdose GLP-1 regimen changes flares, lesions or pain.

The modest weight change in the pooled data does not fill that gap. A drug can produce a small average BMI change at a full dose for many reasons, including short follow-up and mixed populations, and that tells us nothing about what a fraction of the dose would do to HS inflammation.

The summary is narrow. Observational studies and patient surveys link GLP-1 medicines with less severe HS and better quality of life, mostly in people with obesity or diabetes. Registry data show HS treatments and surgery fall over time whether or not people start a GLP-1. Controlled trials are still needed, and HS treatment decisions, including whether a GLP-1 belongs alongside antibiotics, biologics or surgery, sit with a dermatologist and prescriber.

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