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You may have heard of metformin as a drug to help treat diabetes mellitus but when it comes to treating skin conditions like hidradenitis suppurativa, a doctor must be crazy if he prescribes you this, right? There may be a method to his madness.

Hidradenitis suppurativa is a not only a disease that is intimidating for patients and physicians to pronounce, but it is also a complicated disease to treat. Science has been able to discover that clogged pores, brittle hair follicles and a sudden surge of sex hormones during puberty tend to cause some patients to have sudden outbursts of pimple-like projections under a patient's arms, around their groin and skin folds [1]. These are not simple pimples, these lumps are extremely painful and can become infected with dangerous bacteria. Countless efforts have been made to find a treatment option that will successfully stop this process from occurring, but a proper hidradenitis suppurativa treatment is still lacking. The current recommendation is to try to treat it with topical creams, but when symptoms become too severe, the only option to try to defeat the pain would be hidradenitis suppurativa treatment with lasers and surgery.  [2]. 

The Link Between Metformin and Hidradentiis Suppurativa 

Even these aggressive therapies do not guarantee a cure and many patients will relapse with new blemishes. Stopping flare-ups from occurring is another school of thought that patients may benefit from and numerous natural treatments for hidradenitis suppurativa can help alleviate some of the struggles patients encounter. One potential suggestion for a prophylactic intervention entails using metformin, a drug normally seen in patients suffering from Diabetes Mellitus. Is there some merit in hidradenitis suppurativa treatment with Metformin? 

It is true that metformin will be a good option for patients suffering from problems with their sugar and it is a staple in any treatment regimen in a patient with Type 2 Diabetes but what does that have to do with hidradenitis suppurativa [3]? There is a strong underlying link between these two seemingly independent diseases. When patients suffer from hyperglycemia, the levels of insulin in their bodies will also be very high to try to try to reduce the sugar levels back to normal. There is a very complicated physiological explanation for why this happens but in the event, you are reading this at home and don't have a medical degree, I'll simplify it to a more straightforward concept. High levels of insulin lead to high levels of growth hormone. As the levels of growth hormone increase, sebaceous glands become more active and more acne is produced. If your mother ever told you not to eat sugar because it would cause pimples, it turns out she was right. 

Metformin works by preventing new sugar from being formed and making insulin more efficient at processing the sugar in our blood circulation [4]. This effectively lowers blood sugar, insulin levels, growth hormone and finally, acne production. As a result, it is becoming a more and more popular therapy in the dermatological world as a therapy for patients suffering from a number of conditions associated with skin conditions and imbalances in sugar production. Doctors around the world currently are prescribing metformin for patients suffering from hormonal acne, acanthosis nigricans, eruptive xanthomas, psoriasis and even hidradenitis suppurativa. [5]

Could it be an Effective Therapy? 

Metformin was put to the test to determine if it could be a useful hidradenitis suppurativa treatment for patients with unrelenting HS flare-ups non-responsive to more traditional therapies. In this experiment, 25 patients were recruited and asked to take metformin for six months to determine if there was any effect on symptoms following this medication. At the conclusion of the 6-month investigation, researchers determined that in 18 patients (more than one-third of patients), there was a clinical improvement. Patients reported having an overall higher quality of life compared to levels assessed at the start of the trial. Researchers also found that there was a reduction of work days lost due to symptoms by nearly 66 percent. Not only will you feel better, but your boss will also be happier. [6]

In the early stages of investigation with metformin, a trend that has already surfaced is patients that tend to be overweight benefit more from metformin therapy compared to patients with a normal BMI level. This conclusion makes sense based on the mechanism of what is occurring that I explained briefly in the last passage. [7]

Unfortunately, however, metformin seems to do little to benefit other patients not suffering from glucose intolerance. Consider metformin to be just like the other therapies we have investigated so far for hidradenitis suppurativa treatment options. There are time and place where metformin will be considered to be a great option, but it is not appropriate for everyone. It gives us doctors another trick in our arsenal to try to help patients manage their symptoms, but hidradenitis suppurativa treatment with metformin will not keep your HS from coming back.