Hidradenitis Suppurativa and Stress

Hidradenitis Suppurativa and stress can be closely connected for some people. Two hormones involved in the stress response are cortisol and aldosterone. Let us look at how they work and how, together with insulin, which I discussed previously, they may affect the body's balance. This article shares my personal experience and general information. I am not a doctor, and it is not medical advice. HS has no definitive cure, and stress is only one of many factors that may influence symptoms.

Cortisol

Cortisol, also known as the stress hormone and synthesized from cholesterol through pathways that include pregnenolone, is produced by our bodies in response to events that disrupt homeostasis, the body's natural state of balance.

Maintaining cortisol within a healthy range is important because it affects many aspects of health, including:

physical performance;
fluid retention;
muscle breakdown;
fat storage;
fatigue and insulin regulation;
immune function;
mental health, including depression and anxiety.

Prolonged stress can alter the body's hormone production and regulation. The idea that the body literally "steals" pregnenolone to make cortisol is an oversimplification. Pregnenolone is involved in pathways that also produce sex hormones, which I discussed in a previous article, and chronic stress can still affect hormonal balance through several pathways.

This may contribute to significant hormonal changes, although the effects vary from person to person.

The following habits may help support stress management and healthy cortisol regulation:

getting regular, adequate sleep;
following a balanced diet;
eating enough to support recovery after intense exercise, since very long or demanding workouts can temporarily raise cortisol;
choosing fruit and vegetables rich in antioxidants;
including sources of Omega-3 fatty acids in your diet;
staying well hydrated;
reducing an overly hectic pace where possible;
limiting exposure to extreme weather when it aggravates your symptoms.

Aldosterone

Another hormone that may be relevant to the relationship between Hidradenitis Suppurativa and stress is aldosterone.

This is another steroid hormone produced through pathways that begin with pregnenolone. It acts mainly on the kidneys and cardiovascular system, helping the body maintain appropriate salt and water levels.

Aldosterone also acts in other tissues throughout the body. It promotes sodium retention and potassium excretion, including through processes involving the sweat glands, intestines, and tear glands. Its primary site of action, however, remains the kidneys.

Excess aldosterone can contribute to high blood pressure, weakness, fatigue, and headaches. Its regulation is complex and involves blood volume, sodium and potassium balance, kidney signaling, medications, and certain health conditions. Stress hormones can interact with this system, but persistent symptoms or suspected hormone imbalances require medical assessment.

Studies have shown that some receptors for this hormone are also found in the skin, including the sebaceous glands, sweat glands, and hair follicles. Sweat also helps the body release small amounts of sodium.

After sodium is lost through sweating, aldosterone can help the kidneys retain sodium and keep its levels stable.

Some researchers have explored whether altered salt balance and hormone signaling in the skin could affect sebaceous and sweat gland function. However, the idea that excess sodium directly "hardens" sebum in our glands and promotes HS symptoms has not been established. It should not be used as a reason to change your salt intake without guidance from a qualified healthcare professional.

Insulin, Stress Hormones, and Sex Hormones

You now have a clearer overview of how Hidradenitis Suppurativa and stress may be connected.

Do you remember how, when discussing insulin, I mentioned its important role in maintaining the body's balance?

Now that we have looked at these hormones, you can revisit the two previous articles, the one about sex hormones and the one about insulin, if you have not read them. Together, they help explain why insulin is one part of a complex hormonal system.

Insulin is essential for helping regulate blood glucose. It works alongside other hormones that can raise glucose when it falls below a healthy range.

Cortisol is one of those hormones.

When we develop insulin resistance, the pancreas may produce more insulin to help lower blood glucose. Cortisol also influences glucose regulation, especially during stress, although the relationship is more complex than a simple one-to-one response.

Periods of increased cortisol demand involve changes across several hormone pathways, including those that begin with cholesterol and pregnenolone.

Pregnenolone is also part of the pathways involved in producing DHEA, and DHEA can be converted into androgens and estrogens. Chronic stress, insulin resistance, and sex hormones may interact, but current evidence does not support the idea that cortisol simply takes pregnenolone away from other hormones. The key point is that metabolic and hormonal systems are closely connected, and disturbances in one area may influence the others.

Hidradenitis Suppurativa and Stress

Cortisol

Aldosterone

Insulin, Stress Hormones, and Sex Hormones

Sources

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