GLP-1 Medications and Hidradenitis Suppurativa: What the Research Shows

*Compounded semaglutide and compounded tirzepatide are not FDA-approved. This article is for educational and informational purposes only. It does not constitute medical advice. Consult a licensed healthcare provider before starting, stopping, or adjusting any medication. Care at Prescriva is delivered by independently licensed providers, not by Prescriva LLC, doing business as Prescriva, which is a management services organization.*

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Most people know that GLP-1 receptor agonists help with weight loss. Fewer know that researchers are now studying their potential role in a painful, often misunderstood skin condition called hidradenitis suppurativa.

The connection is not accidental. Hidradenitis suppurativa and obesity share deep biological ties, and the same metabolic dysfunction that drives weight gain appears to fuel this inflammatory skin disease. As GLP-1 medications become more widely used, dermatologists and patients with HS are starting to ask the same question: could treating metabolic health also help calm this condition?

Here is what the current research shows, what it does not yet prove, and what it might mean for people managing both conditions.

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What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa (often shortened to HS) is a chronic inflammatory disease affecting the hair follicles in areas where skin rubs against skin: the armpits, groin, inner thighs, and under the breasts. It is not an infection, though it is commonly mistaken for one.

The condition causes painful nodules, abscesses, and in more advanced cases, tunnels beneath the skin called sinus tracts. These can drain, scar, and significantly restrict movement. The disease tends to flare and remit over years or decades, often worsening with heat, friction, sweat, and hormonal shifts.

HS affects approximately 1 to 4 percent of the general population, though it is likely underdiagnosed. Many people live with it for years before receiving a correct diagnosis. The quality-of-life burden is substantial: chronic pain, social withdrawal, depression, and work disruption are common.

Treatment options include topical and systemic antibiotics, hormonal therapies, and for moderate to severe disease, biologics such as adalimumab (the only FDA-approved biologic for HS). Surgery may be required for recurrent or scarred lesions.

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The Metabolic Connection: Why Obesity and Insulin Resistance Matter

HS does not exist in isolation. Research has consistently found that it clusters with a set of metabolic comorbidities that look familiar to anyone familiar with obesity medicine.

People with HS have significantly higher rates of obesity, type 2 diabetes, metabolic syndrome, polycystic ovary syndrome, and cardiovascular disease compared to the general population. A 2025 review in *Clinics in Dermatology* documented this comorbidity profile in detail, noting that metabolic dysfunction "should be kept in mind while planning the treatment" for HS patients (Aşkın et al., 2025, PMID: 40414610).

The relationship goes beyond coincidence. Excess adipose tissue, particularly visceral fat, releases pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). These signals appear to drive HS disease activity. Insulin resistance, which occurs in a significant proportion of HS patients, compounds the inflammatory milieu by disrupting normal skin barrier function and immune regulation.

Hyperandrogenism, common in both HS and PCOS, contributes to follicular occlusion that underlies HS pathogenesis. Weight loss by any method has been shown to reduce HS flare frequency, suggesting the metabolic burden is a genuine driver of disease activity rather than just an association.

This is the biological ground on which the GLP-1 hypothesis sits.

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How GLP-1 Medications Might Help

GLP-1 receptor agonists like semaglutide and tirzepatide work primarily through appetite regulation and slowing of gastric emptying, leading to sustained weight loss. But the clinical literature has also documented meaningful reductions in systemic inflammatory markers, including CRP, IL-6, and TNF-alpha, that appear to exceed what weight loss alone would predict.

For HS specifically, researchers have identified two potential pathways:

Weight loss reducing mechanical and inflammatory burden. As adipose tissue decreases, mechanical friction in skin folds lessens. More importantly, the reduction in visceral fat removes a major source of the cytokine signals that fan HS inflammation. Smaller fat depots mean less pro-inflammatory adipokine activity.

Direct metabolic and immunomodulatory effects. GLP-1 receptors are expressed on immune cells, including macrophages and dendritic cells. Preclinical studies suggest that GLP-1 receptor activation can modulate immune responses beyond what weight loss drives. Improvements in insulin sensitivity, which these medications reliably produce, may also blunt the hormonal drivers of follicular occlusion that characterize HS.

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What the Clinical Evidence Shows

The evidence base for GLP-1 medications in HS is early but growing. Most published data comes from case reports, case series, retrospective analyses, and patient-reported outcome surveys. There are no randomized controlled trials yet. That limitation matters when interpreting findings.

Patient-Reported Outcomes

A 2025 study from the Perelman School of Medicine at the University of Pennsylvania surveyed patients with HS who had used GLP-1 receptor agonists. Researchers collected patient-reported outcomes on HS severity, flare frequency, and quality of life. Patients reported improvements in HS activity after starting a GLP-1 medication. This study, published in *JAAD International*, provides early signal from patients themselves rather than clinical measurement alone (Gupta et al., 2025, PMID: 40655535).

Real-World Retrospective Data

A 2026 correspondence in the *Journal of the American Academy of Dermatology* (JAAD) analyzed TriNetX database data to examine whether GLP-1 receptor agonists affected biologic initiation rates in patients with HS. The analysis found that GLP-1 RA use was associated with reduced rates of initiating biologic therapy, suggesting that GLP-1 treatment may have attenuated disease severity enough that some patients did not require escalation to biologics (Kasheri et al., 2026, PMID: 41478501). This is a meaningful signal, because biologics in HS represent a substantial treatment escalation and cost burden.

Narrative Review of Adjunctive Evidence

A 2026 narrative review in the *International Journal of Dermatology* systematically examined the published literature on incretin-based therapies (both GLP-1 receptor agonists and dual GIP/GLP-1 agonists like tirzepatide) as adjunctive treatment for HS in patients with overweight or obesity. Across case reports and observational cohorts, the authors found that these medications were associated with significant weight loss and concurrent improvements in HS disease activity, flare frequency, pain, and patient-reported quality of life (Almukhadeb et al., 2026, PMID: 41729201).

The review emphasized that the current evidence consists predominantly of case-level reports and a limited number of observational cohorts. It also noted the difficulty in separating the direct immunomodulatory effects of GLP-1 receptor activation from the benefits of weight loss itself, since both appear to be at work.

Tirzepatide Specifically

A 2026 review in *Anais Brasileiros de Dermatologia* examined tirzepatide's profile in dermatology more broadly, noting that its dual GIP and GLP-1 receptor agonism and associated weight loss may have particular relevance for inflammatory skin conditions including HS. The review characterized current evidence as "limited to case reports and small studies" while noting tirzepatide's immunomodulatory properties as biologically plausible mechanisms (El-Amawy, 2026, PMID: 41483501).

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What This Means If You Have HS

This research does not mean GLP-1 medications are a treatment for HS. They are not currently prescribed or indicated for HS, and they are not FDA-approved for this condition. GLP-1 medications prescribed through Prescriva are indicated for medically supervised weight management.

What the evidence does suggest is that for people who have both HS and obesity or metabolic dysfunction, weight management through a GLP-1 program may produce secondary benefits for skin inflammation. This is consistent with the broader body of evidence showing that weight loss by any method tends to reduce HS burden.

If you have HS and are considering a GLP-1 program for weight management, the following points are worth discussing with your providers:

Your dermatologist and prescribing provider should both be aware you have HS. Coordinating care between the two allows them to track whether skin symptoms improve and to attribute changes appropriately.

GLP-1 medications take time. Significant weight loss typically begins within the first several weeks of treatment and continues over months. Any secondary HS benefit would likely follow the weight loss trajectory rather than occurring independently.

GLP-1 treatment does not replace existing HS management. Antibiotics, biologics, and surgical interventions remain the standard of care for HS. Adding metabolic treatment does not substitute for dermatologic evaluation and management.

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Limitations and What Is Still Unknown

Several important questions remain unanswered.

Does the GLP-1 receptor itself play a direct role in HS improvement, independent of weight loss? Current evidence cannot cleanly separate these effects, since both weight loss and direct GLP-1 receptor activity appear to occur simultaneously in patients who improve.

Does the type of GLP-1 medication matter? There are no head-to-head comparisons of semaglutide versus tirzepatide for HS outcomes. Tirzepatide's dual mechanism may or may not produce different effects on HS compared to single-receptor agonists.

What happens if patients stop GLP-1 therapy? Weight regain after stopping GLP-1 medications is well documented, and if HS improvements track with metabolic status, discontinuation might lead to HS worsening in some patients.

Randomized controlled trials specifically in HS populations are needed before GLP-1 medications can be considered evidence-based treatment for the condition. The signals are interesting and biologically plausible, but the field is genuinely early.

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A Note on Compounded GLP-1 Medications

Compounded semaglutide and compounded tirzepatide are not FDA-approved and are not FDA-approved generics. The existing HS research has not specifically studied compounded formulations. Any discussion of GLP-1 medications and HS refers to the GLP-1 receptor agonist class broadly, not to any specific compounded preparation.

Prescriva prescribes compounded GLP-1 medications for medically supervised weight management. Prescriptions are issued by licensed providers following individual medical evaluation.

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The Bottom Line

Hidradenitis suppurativa is a metabolic disease as much as it is a skin disease. Its deep association with obesity, insulin resistance, and systemic inflammation means that improving metabolic health may have real downstream effects on disease activity.

The early clinical evidence suggests that GLP-1 medications, prescribed for weight management, are associated with improvements in HS flare frequency, severity, and quality of life in patients who also have obesity. The data comes from case series, patient surveys, and retrospective analyses rather than randomized trials, so conclusions must remain appropriately cautious.

For people managing both conditions, the growing research represents a legitimate reason to discuss metabolic treatment with both their dermatologist and their prescribing provider. The goal is coordinated care that addresses the full metabolic picture, not just the visible symptoms.

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*This article is for informational purposes only and does not constitute medical advice. Compounded semaglutide and tirzepatide are not FDA-approved and are not prescribed for hidradenitis suppurativa. Consult a licensed dermatologist and healthcare provider for diagnosis and treatment of HS.*

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References

1. Gupta R, Cesar L, Micheletti R, Fang V. Patient-reported outcomes of glucagon-like peptide-1 agonists on hidradenitis suppurativa severity. *JAAD International*. 2025;21:40-43. PMID: 40655535.
2. Kasheri E, Smith J, Min MS. Glucagon-like peptide-1 receptor agonists may decrease biologic initiation in hidradenitis suppurativa: A TriNetX retrospective analysis. *Journal of the American Academy of Dermatology*. 2026;94(4):1331-1332. PMID: 41478501.
3. Almukhadeb E, Nagshabandi KN, Alshehri N, et al. Glucagon-Like Peptide-1 Receptor Agonists as Adjunctive Therapy for Hidradenitis Suppurativa in Patients With Overweight/Obesity: A Narrative Review. *International Journal of Dermatology*. 2026;65(6):1168-1175. PMID: 41729201.
4. El-Amawy HS. Tirzepatide in dermatology: cutaneous adverse events, emerging therapeutic roles, and cosmetic implications. *Anais Brasileiros de Dermatologia*. 2026;101(1):501255. PMID: 41483501.
5. Aşkın Ö, Ferhatoğlu ZA, Özkoca D, Cesur SK, Tüzün Y. The comorbidities of hidradenitis suppurativa. *Clinics in Dermatology*. 2025;43(4):449-454. PMID: 40414610.