Increased risk of hidradenitis suppurativa in tobacco but not cannabis users: A retrospective cohort analysis using a large multicenter database

Summary: Abstract Body: Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that causes pain and disproportionately affects women and African American patients. There is conflicting evidence that tobacco smoking influences HS development, and the relationship between cannabis and HS is unexplored. Therefore, we assessed the risk of developing HS with tobacco and cannabis use to help counsel patients about potential modifiable risk factors. Methods: TriNetX research database was searched on 11/21/2024 for patients ages ≥18-years who used tobacco only, cannabis only, and both tobacco and cannabis from 2000-2020. Propensity score matching was performed by age, sex, race and ethnicity. Odds ratios of developing HS ≥1 day following tobacco use, cannabis use, or both were calculated. Results: We identified 807,675, 315,695, and 48,442 patients who used tobacco only, cannabis only, or both, respectively. After matching for age, sex, race and ethnicity, patients with tobacco use only and both tobacco and cannabis use had higher odds of HS diagnosis (OR 2.23, 95% CI 2.13-2.33, and 2.11, 1.80-2.48, respectively), but not patients with cannabis use only (0.96, 0.90-1.03). Among patients with tobacco use only, odds of HS diagnosis were higher for females vs. males (2.86, 2.67-3.05) and Black vs. White patients (1.68, 1.56-1.81), whereas odds of HS diagnosis were lower for Asian vs. White patients (0.56, 0.39-0.81). Conclusions: We showed that tobacco use was associated with higher odds of HS diagnosis, which is a relationship that has been controversial in the literature. Our study also found that cannabis use was not associated with increased odds of HS diagnosis, which has not been previously established. Prospective studies are needed to reproduce this data. We recommend that dermatologists obtain tobacco and cannabis use histories for HS patients and counsel on smoking cessation. Naeha Pathak¹, Omar Alani¹, Dev Patel¹, Shari Lipner² 1. Icahn School of Medicine at Mount Sinai, New York, NY, United States. 2. Dermatology, Weill Cornell Medicine, New York, NY, United States. Clinical Research: Epidemiology and Observational Research