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The very low-calorie ketogenic diet (VLCKD) has shown efficacy in addressing obesity, related metabolic disorders, and reducing chronic inflammation. However, its effects on HS remain underexplored. In this prospective pilot study, we aimed to investigate the impact of a 28-day active phase of VLCKD on HS in a sample of treatment-naive women with HS and excess weight.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twelve women with HS and overweight or obesity (BMI 27.03 to 50.14\u00a0kg\/m<jats:sup>2<\/jats:sup>), aged 21 to 54\u00a0years, meeting inclusion\/exclusion criteria and agreeing to adhere to VLCKD, were included. Baseline lifestyle habits were assessed. The Sartorius score was used to evaluate the clinical severity of HS. Anthropometric parameters (waist circumference, weight, height, and body mass index), body composition <jats:italic>via<\/jats:italic> bioelectrical impedance analysis, levels of trimethylamine N-oxide (TMAO), oxidized low-density lipoprotein (oxLDL), and derivatives of reactive oxygen metabolites (dROMs) were assessed at baseline and after 28\u00a0days of the active phase of VLCKD.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>VLCKD led to general improvements in anthropometric parameters and body composition. Notably, a significant reduction in the Sartorius score was observed after the intervention (\u0394%: \u2212\u00a024.37\u2009\u00b1\u200916.64, p\u2009&lt;\u20090.001). This reduction coincided with significant decreases in TMAO (p\u2009&lt;\u20090.001), dROMs (p\u2009=\u20090.001), and oxLDL (p\u2009&lt;\u20090.001) levels. Changes in the Sartorius score exhibited positive correlations with changes in TMAO (p\u2009&lt;\u20090.001), dROMs (p\u2009&lt;\u20090.001), and oxLDL (p\u2009=\u20090.002).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The 28-day active phase of VLCKD demonstrated notable improvements in HS severity and associated metabolic markers, highlighting the potential utility of VLCKD in managing HS and its association with metabolic derangements in women with overweight or obesity.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12967-024-04853-0","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T10:02:25Z","timestamp":1707818545000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Very\u00a0low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): an effective and safe tool for improvement of the clinical severity of disease. 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