Obesity, Insulin Resistance and Dysregulation of the mTOR Signalling Pathway in Hidradenitis Suppurativa

ivana Tusheva; Irena Dimitrovska; Vesna Trajkova; Vesna Brishkoska-Boshkovski; Tatjana Ruskovska

doi:10.3889/oamjms.2026.12113

Authors

ivana Tusheva Department of Dermatology, City General Hospital "8th September" Skopje, North Macedonia https://orcid.org/0009-0007-2193-8742
Irena Dimitrovska Department of Dermatology, City General Hospital "8th September" Skopje, North Macedonia
Vesna Trajkova Department of Dermatology, City General Hospital "8th September" Skopje, North Macedonia
Vesna Brishkoska-Boshkovski Department of Dermatology, Acibadem Sistina Clinical Hospital, Skopje, North Macedonia; Faculty of Medical Sciences, Goce Delchev University, Shtip, North Macedonia https://orcid.org/0000-0002-1580-6117
Tatjana Ruskovska Faculty of Medical Sciences, Goce Delchev University, Shtip, North Macedonia

DOI:

https://doi.org/10.3889/oamjms.2026.12113

Keywords:

hidradenitis suppurativa, obesity, insulin resistance, IHS4, mTOR, metformin

Abstract

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses, and draining tunnels, with a predilection for intertriginous regions.

AIM: We aimed to review dysregulation of mTOR signalling pathway based on the latest relevant scientific studies.

METHODS: This literature review explores the association between HS, obesity, insulin resistance, and the dysregulation of mTOR signalling pathway. Additionally, research investigating the effects of therapeutic strategies, such as metformin and its influence on clinical outcomes in HS patients, was analyzed.

RESULTS: Obesity is considered a predisposing factor for the development of insulin resistance and type 2 diabetes, both of which influence the IHS4 (International Hidradenitis Suppurativa Severity Score System) score in HS patients. The prevalence of insulin resistance among HS patients is 43.4%. Studies have shown that metformin significantly reduces inflammatory cytokines, chemokines, and the expression of genes associated with glycolytic processes. In vitro analyses suggest that these effects are mediated through the modulations of the NLRP3 inflammasome and mTOR signalling pathway.

CONCLUSION: A holistic approach to HS treatment, including the management of obesity and insulin resistance, significantly improves disease progression. The use of metformin as an adjunct therapy in standard treatment protocols has the potential to improve IHS4 scores in obese patients.

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