Quitting smoking and maintaining smoking-free status may reduce risk of hidradenitis suppurativa onset: JAMA

Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and scarring, leading to important morbidity. Tobacco smoking is considered an established risk factor for HS, but little has been done regarding investigations on the impact of smoking cessation on HS. Thus, this study was carried out to determine any change in smoking status that could be associated with the development of HS during follow-up.

This was a cohort study using data from the Korean National Health Insurance Service, including subjects aged 30–70 years who underwent two consecutive biennial health examinations between 2004 and 2007. For the main cohort of 6,230,189 people, changes in smoking status were tracked, while subsequent HS incidents were monitored until the end. A secondary subcohort comprised those individuals whose smoking status did not change from the 2006–2007 examination through the end of follow-up.

Smoking habits were categorized into several groups: sustained smokers, smoking quitters, those who maintained cessation, never smokers, those who resumed smoking after quitting, and new smokers. The study’s primary outcome was the risk of HS development, which was assessed using a Cox proportional hazards model. Data analysis was conducted from July to December 2023.

Key Findings

• This investigation enrolled 6,230,189 individuals with a mean age of 47.2 years; 55.6% were male. During 84,457,025 person-years of follow-up, there were 3,761 new cases of HS.

• Compared to sustained smokers, those who had quit smoking by the second health checkup showed a reduced risk of HS by 32% during follow-up. Those who remained sustained at cessation throughout the study period also saw a similar reduction in the risk. Never smokers were at the lowest risk with an (AHR of 0.57;95% CI;0.52-0.63).

• Those subjects who had resumed smoking from an initial quitter, as well as those who began smoking during follow-up, experienced an HS risk similar to the sustained smokers, highlighting the poor result of resuming smoking habits.

• The cumulative incidence and HS risk for smoking quitters were comparable to that of sustained smokers through the first 3 to 4 years of abstinence but were significantly lower, and closer to that of never smokers, thereafter. This reduction remained significant over time: between 3 and 6 years, (AHR 0.58, 95% CI 0.36-0.92; ≥12 years, AHR 0.70, 95% CI 0.50-0.97).

• The new smokers had a risk similar to that of the never smokers initially but increased after 2 to 3 years to a risk comparable to that in the sustained smokers.

This large-population cohort study confirms the necessity of smoking cessation in patients at risk for HS. The reduction in risk for this chronic condition could be greatly reduced by sustained abstinence from smoking and prevention of relapse. The study also underlined that starting or resuming smoking might be related to a rapid increase in HS risk, as observed in persistent smokers.

In this study, it was summarized that quit smoking and continual smoke-free status were significantly associated with a reduced incidence of hidradenitis suppurativa. On the other hand, resuming or initiating smoking was associated with an increased risk for HS, comparable to that of continuous smokers. These results reiterate the important role of smoking cessation in attenuating the burden of HS and improving overall dermatologic health outcomes.

Reference:

Kim, S. R., Choi, Y.-G., & Jo, S. J. (2024). Smoking cessation and risk of hidradenitis suppurativa development. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2024.2613