Comparison of clinical characteristics and phenotypes of hidradenitis suppurativa by smoking status

Summary: Abstract Body: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition with smoking as an established risk factor. However, the influence of smoking on disease characteristics and phenotypes remains unknown. This study aims to evaluate the relationship between smoking status and HS phenotypes, demographic characteristics, and clinical features. A retrospective cross-sectional study was conducted with 1,616 HS patients which were stratified by smoking status. Phenotypic distributions, demographic characteristics, and clinical features were compared across groups. A chi-square test was performed to evaluate the independence of HS phenotype by smoking status. Regular phenotype was most common in non-smokers (77.2%) compared to current (56.8%) and former smokers (64.2%). Conversely, scarring folliculitis was more prevalent in current smokers (23.4%) and former smokers (14.8%) than in non-smokers (4.1%) (p < 0.01). Other advanced phenotypes, such as conglobata and syndromic HS, were more frequently observed in smokers than in non-smokers. Current smokers showed a higher prevalence of hypertrophic or keloid scarring (8.8%), and honeycomb or cribriform scars (19.8%) compared to former (7.9% and 16.1%, respectively) and non-smokers (6.7% and 8.9%, respectively). Additionally, Hurley stage III was more frequent in current (36.2%) and former (39.4%) smokers when compared to 32.7% in non-smokers. Smokers, both current and former, are more likely to exhibit the scarring folliculitis phenotype and advanced Hurley stages when compared to non-smokers. These findings reiterate the importance of smoking cessation as a potentially critical component of HS management in an effort to mitigate disease progression and severity. Further research is needed to explore the pathophysiological mechanisms linking smoking and specific HS phenotypes and clinical characteristics. Teja Mallela¹, Christopher Sayed¹ 1. Department of Dermatology, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States. Clinical Research: Epidemiology and Observational Research