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Hidradenitis Suppurativa and Smoking

Posted on February 19, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Sage Salvo

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease characterized by painful, recurring bumps on the skin (known as abscesses), typically in the armpits, groin, buttocks, and the underside of the breasts.

The severity of HS varies from person to person. However, certain factors and comorbidities (simultaneous presence of two or more medical conditions) are believed to worsen or even trigger the condition. These include age, biological sex, family history, and obesity. Among the environmental factors thought to contribute to HS is smoking.

What’s the Relationship Between HS and Smoking?

The link between hidradenitis suppurativa and smoking is well-documented. Past studies have found that the prevalence of HS among tobacco smokers is nearly double that of nonsmokers. One study found that the odds of a new HS diagnosis increased 90 percent for people who smoke tobacco.

Experts agree that HS typically occurs after hair follicles in the skin become blocked. However, they don’t know the exact causes of the condition. Certain factors may contribute to the development of HS — and smoking has been called one of the most impactful environmental factors.

Some experts suggest that certain chemicals in tobacco smoke may weaken a person’s immune defenses and increase bacterial virulence (strength). This means that if a person is already genetically predisposed to HS and then smokes, they may be more likely to develop the condition — or, if they already have HS, they may experience more severe symptoms. Research also indicates that smokers who have hidradenitis suppurativa tend to have a higher number of body areas affected by the disease than those who do not smoke or have stopped smoking.

That said, researchers have debated the extent to which smoking may play a role in the development of HS. Some experts, for instance, have questioned whether smoking increases a person’s risk of developing HS, or whether smoking is a consequence of HS itself: The high rates of depression and anxiety among people with HS may lead people to cigarette smoking as a coping mechanism.

Smoking’s Impact on HS Treatment and Remission

Ideally, someone with HS might receive care from a specialist, like a dermatologist, and achieve remission — a state where they don’t have any inflammatory wounds. However, remission can be hard to achieve even in ideal circumstances, as HS is a lifelong condition. Smoking may make achieving remission even more difficult, and it can have a negative impact on a person’s treatment of hidradenitis suppurativa.

One 2014 study on HS outcomes found that 40 percent of nonsmokers achieved remission, compared to just 29 percent of smokers. Similarly, in 2016, a study published in the Journal of the American Academy of Dermatology reported that participants who didn’t smoke were more likely to respond well to conventional treatments, such as antibacterial washes and lotions, topical and oral antibiotics, and intralesional corticosteroids.

Will Stopping Smoking Improve HS?

Because of the association between smoking and lessened response to treatment, experts recommend that people with HS stop smoking tobacco. Smoking cessation appears to help reduce the symptoms of HS. The aforementioned 2016 study found that people with HS who had stopped smoking or never smoked were substantially more likely to see an improvement in their condition than current smokers.

Quitting smoking can be difficult, but having a strong support network can help. Members of myHSteam encourage one another to remain hopeful and focused on tracking their goals. “Please don’t get discouraged! Smoking is not good for you — not just your HS, but for you,” one member told another. “If you can beat that battle with smoking, you can definitely fight HS back. We’re here for you.”

Avoiding secondhand smoke can also be challenging, especially if your friends or family still smoke cigarettes. “My friend came to visit, and against my protest and begging him not to, he insisted on smoking in my vehicle,” shared a myHSteam member. “That’s one of my worst triggers. Now I’m broken out everywhere.”

A third myHSteam member shared words of inspiration: “I know I’m not dirty. I know that I can control this. … It won’t control me anymore!” They added that they were considering going to a psychiatrist “to talk out [their] anger and frustrations.”

Find Your Support System

Regardless of where you are in your hidradenitis suppurativa treatment journey, you are not alone. Joining myHSteam — the social network for people with HS — allows you to give and receive support from people who truly understand your experience. You can gain practical advice on managing your hidradenitis suppurativa. With myHSteam, you can forge real friendships, engage in mutual support, and share the daily ups and downs of life in a judgment-free space.

Do you have advice to give or questions to ask? Add a comment below, or share your experiences with the myHSteam community by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sage Salvo is a content creator who specializes in developing savvy, SEO-aware content strategies and top notch ghostwritten articles for a wide variety of industry niches. Learn more about her here.

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