The effect of smoking and age on the response to first-line therapy of hidradenitis suppurativa: An institutional retrospective cohort study

Abstract

Background Treatment for HS (hidradenitis suppurativa) is often empiric and inadequate, and determining which patients will respond is difficult. Objective To determine which patient factors are associated with a positive response to first-line medical therapy. Methods A single-center retrospective cohort study of all HS patients seen between 1/1/1992 and 10/1/2014 was conducted. Response to first-line medical therapy (oral/topical antibiotics, intralesional corticosteroids, and topical washes) was examined at follow-up within 6 months of initiating therapy. A multivariate binary logistic regression model was built examining response to treatment and the interplay of patient factors and treatment initiated. Results 198 patients were included in the final model. Non-smokers (OR=2.634, 95%CI=1.301-5.332, p=0.007) and older individuals (OR=1.046 for each additional year, 95%CI=1.020-1.072, p<0.001) were more likely to have improvement at follow-up. Additionally, current smokers differed significantly from non-smokers in several regards. Limitations The retrospective nature of this study and relying on classification of disease severity from physical exam findings in some patients. Conclusions The results of this study suggest that clinicians may be able to more accurately predict which patients with HS will respond to first-line medical therapy, and which patients may require therapy escalation.

Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A.

“…12 In a single-centre retrospective cohort study that included 198 U.S. patients with HS, former smokers or nonsmokers had nearly three times the odds of achieving a response to conventional medical therapies, including antibacterial washes/creams/lotions, topical and oral antibiotics, and intralesional corticosteroids. 42 This study supports the common belief among dermatologists caring for patients with HS that tobacco smoking is associated with HS and represents a risk factor for the disease. Our analysis of HS incidence includes the largest and most heterogeneous cohort of tobacco smokers sampled from various healthcare settings across all U.S. census regions.…”

“…Those with HS who did not smoke had 2·8 times the odds of self‐reported remission compared with smokers . In a single‐centre retrospective cohort study that included 198 U.S. patients with HS, former smokers or nonsmokers had nearly three times the odds of achieving a response to conventional medical therapies, including antibacterial washes/creams/lotions, topical and oral antibiotics, and intralesional corticosteroids …”

SAPHO syndrome associated with hidradenitis suppurativa and pyoderma gangrenosum successfully treated with adalimumab and methotrexate: a case report and review of the literature

“…As HLA‐B27 contributes to the development of spondyloarthropathies, it has been suggested that SAPHO syndrome belongs within the spectrum of spondyloarthropathies . Only one study described smoking status, which is important as a driver of inflammation in autoinflammatory syndromes and may lead to inadequate response to therapy . Our patient was a long‐term smoker who was successful with smoking cessation after review at our clinic.…”

Association between smoking and Behçet's disease: a nationwide population‐based study in Korea

“…23 Psoriasis is related to smoking, and it has been reported that heavier smoking increases both the relative risk and severity of psoriasis. [24][25][26][27] Smoking is considered a triggering factor in hidradenitis suppurativa [28][29][30][31][32][33][34] and systemic lupus erythematosus. [35][36][37] It affects adversely on wound healing 38 and skin ageing.…”