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Smoking cessation was associated with a significant reduction in the risk of developing hidradenitis suppurativa (HS) compared with continuous smoking, according to a Korean population-based cohort study.

Compared with patients who reported active smoking across two consecutive biennial health exams, a lower risk of HS was seen among those who smoked initially but quit by the second exam (adjusted HR 0.68, 95% CI 0.56-0.83), reported Seong Jin Jo, MD, PhD, of Seoul National University College of Medicine, and colleagues.

Those who maintained cessation status throughout both exams (aHR 0.67, 95% CI 0.57-0.77) and those who reported never smoking at either health exam (aHR 0.57, 95% CI 0.52-0.63) also had lower HS risks compared with active smokers, they noted in

Meanwhile, those who initially quit smoking but resumed by the second exam and those who had no previous smoking history but started by the second exam had similar risk of HS as sustained smokers.

"Given the revealing a in Western countries, the importance of lifestyle modification for disease prevention is further emphasized," Jo and team wrote.

This "chronic inflammatory skin disorder characterized by painful nodules, abscesses, and tunnel formation in intertriginous areas, poses a substantial burden on affected individuals," they explained. Among multiple causes of HS, including genetic predisposition, immune dysregulation, and environmental factors, "smoking has been consistently associated with an elevated risk of HS, exacerbation of the condition, and reduced treatment effectiveness."

Secondary cohort results -- comprising patients who underwent all biennial health exams and maintained the same smoking status from 2006-2007 (the second exam period) to the end of the follow-up period (up to 14 years) -- aligned with those of the primary cohort, showing a more pronounced risk reduction with smoking cessation (aHR 0.57, 95% CI 0.39-0.83).

Risk of HS among smokers who quit was initially similar to that of sustained smokers, the authors noted, but after 3 to 4 years being smoke-free, the rate slowed to resemble that of never-smokers. Furthermore, the decrease in risk persisted at 3 to 6 years (aHR 0.58, 95% CI 0.36-0.92) and more than 12 years from the index date (aHR 0.70, 95% CI 0.50-0.97).

New smokers initially had HS risk that was similar to never-smokers, but risk increased after 2 to 3 years, reaching sustained smokers' levels.

"While there was a remarkable trend of reduced HS risk associated with tobacco consumption decline from sustained smokers to never smokers, no statistically significant differences in HS risk were observed among sustained smokers, relapsed smokers, and new smokers, and no statistically significant difference in HS risk was observed between smoking quitters and sustained ex-smokers," Jo and colleagues wrote.

In an , Alexandra Charrow, MD, MBE, of Harvard Medical School and Brigham and Women's Hospital in Boston, and Leandra A. Barnes, MD, of Stanford University School of Medicine in Palo Alto, California, noted that "this benefit of smoking cessation is seen across covariate subgroups, including weight status, alcohol intake, physical activity, and comorbidity indices."

"This study advances the literature in 3 ways: (1) through a longitudinal cohort design that more clearly elucidates the association between smoking cessation and HS onset, (2) by solidifying a timeline from smoking initiation to increased risk of HS incidence, and (3) by doing so in a large East Asian cohort that has, to our knowledge, not been investigated previously," they wrote.

For this study, Jo and colleagues included 6,230,189 participants from the Korean National Health Insurance Service database who had undergone two consecutive biennial health examinations (2004-2005 and 2006-2007) as the primary cohort. Mean age was 47.2 years, and 55.6% were men.

During 84,457,025 person-years of follow-up, 3,761 HS events occurred.

The authors acknowledged limitations to their study, including potential confounders such as hereditary background, lack of inclusion of users of electronic cigarettes or nicotine replacement therapy, and the small proportion of female smokers.

In addition, in contrast to prior , a lack of difference in HS risk by income level was found in Korean patients, potentially limiting generalizability.

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