The Effects of Smoking Cessation on the Skin: Hidradenitis Suppurativa

Original Article: Smoking Cessation and Risk of Hidradenitis Suppurativa Development

What are the key takeaways of this article?

Hidradenitis Suppurativa (HS) is a chronic and inflammatory skin disorder characterized by painful nodules, abscesses, and tunnel formation in skin fold areas, such as the axilla, groin, perianal, and inframammary regions. These presentations can be very painful and pose a significant health burden. Many factors have been associated with the pathogenesis of HS, including environmental factors such as cigarette smoking. Smoking in general is well-known to be associated with an increased risk and exacerbation of HS, as well as reduced treatment efficacy. However, a majority of the studies producing these results focus on individuals who currently smoke, formerly smoked, or have never smoked at all based on their smoking status at one single time point.

In this population-based cohort study, Kim et al. examined the association between changes in smoking status and the development of HS. Study participants were divided into 6 groups based on their smoking status at 2 checkups: (1) those who consistently smoked (sustained smokers), (2) those who initially quit but resumed prior to the second checkup (relapsed smokers), (3) those with no smoking history but who started smoking prior to the second checkup (new smokers), (4) those who smoked initially but quit prior to the second checkup (smoking quitters), (5) those who were previously smokers and maintained cessation (sustained ex-smokers), and (6) those who never smoked at all (never smokers).

The authors determined that relapsed smokers (adjusted harms ratio [AHR] for HS 0.90) and new smokers (AHR 1.02) did not show a statistically significant difference in the risk of HS development compared with the control group of sustained smokers. In comparison, smoking quitters (AHR 0.68), sustained ex-smokers (AHR 0.67), and never smokers (AHR 0.57) all had a decreased risk of HS development compared to sustained smokers. It is noteworthy that statistical significance was reached only in certain observation periods. Smoking quitters reached a significant difference between 3-6 (p<0.05), 6-9 (p<0.01), and >12 years (p<0.05), while for sustained ex-smokers it was between 6-9 (p<0.001), 9-12 (p<0.01), and >12 years (p<0.001). For never smokers, all observational periods displayed statistical significance starting with 0-3 years (p<0.01) and from 3 to >12 years (all groups p<0.001).

Interestingly, among smoking quitters there was a similar increase in the incidence of HS compared with sustained smokers for approximately 3-4 years after cessation. After this time period, the rate of increase was found to decelerate and resemble that of never smokers. In contrast, new smokers were found to have a rate of increase in HS incidence similar to that of never smokers for approximately 2-3 years then accelerating after this time period to reach levels comparable to that of sustained smokers.

Unfortunately, the limitations of this study include possible confounding factors that may not be accounted for due to its retrospective nature. Also, a questionnaire was used to determine participant smoking status, which may not always accurately reflect actual smoking habits.

In summary, this study contributes to the importance of assessing lifestyle factors, which may contribute to HS. Ideally, physicians should have open discussions with patients regarding lifestyle modification for disease prevention, especially in the case of HS, given the known association with smoking. The results of this study may prove to be beneficial in motivating clinicians and patients to prioritize smoking cessation in cases of HS and as a preventative measure to reduce the risk of HS development.

Publication Date: October 14, 2024

Reference: Kim SR, Choi YG, Jo SJ. Smoking Cessation and Risk of Hidradenitis Suppurativa Development. JAMA Dermatol. Published online August 21, 2024. doi:10.1001/jamadermatol.2024.2613

Summary By: Taylor Skinner