The Dose-Response Relationship between Tobacco Smoking and Hidradenitis Suppurativa: Results from an Observational Study of 1,689 Patients Available to Purchase

Introduction: Available studies show conflicting results on the relationship between smoking characteristics (age at beginning, importance of consumption) and disease characteristics (disease onset, phenotype, and severity). The objective of the study was to better understand the influence of smoking on hidradenitis suppurativa (HS) characteristics. Methods: The clinical characteristics and smoking habits of 1,689 HS patients were assessed and compared between never, past, and active smokers using Student’s t, Fisher’s exact, and χ² tests. Association analyses were done using Spearman’s method and logistic regressions. Results: There was a positive association between the mean age at smoking onset and the mean age at HS onset (ρ = 0.4; p < 0.001). Smokers were associated with a more severe disease: the number of affected sites was positively associated with the number of pack-years (ρ = 0.126, p = 0.0002). There was also a significant association between active smoking and a poorer quality of life (p < 0.001), as well as increased pain during HS flares (p < 0.003). Conclusion: Smoking early is associated to earlier onset of HS and heavy HS smokers develop a more severe disease in a dose-response manner. These results may support evidence-based counseling efforts for smoking cessation in HS patients and patients at risk of HS.

There are gaps in our understanding of the influence of tobacco smoking in disease onset and activity in hidradenitis suppurativa (HS). Our results are in favor of smoking directly influencing HS onset, HS phenotype, and disease severity in a dose-response manner. This study suggests that smoking cessation should be systematically promoted in HS patients.