Hidradenitis Suppurativa and Smoking: Does Quitting Help?

If you live with hidradenitis suppurativa and smoking in the same sentence, you have probably heard it from a dermatologist already: stop smoking. It can feel unfair to be told to change a habit when the condition itself is painful and exhausting. This guide sets out what is actually known about the link, how strong the evidence is for each claim, and what quitting can and cannot be expected to do. It does not replace advice from your own dermatologist or GP.

What hidradenitis suppurativa is

The NHS describes hidradenitis suppurativa as “a painful, long-term skin condition that causes skin abscesses and scarring on the skin.” It usually affects areas where skin folds and sweat glands sit near hair follicles, such as the groin, armpits, bottom and below the breasts. It is thought to affect about 1 in 100 people, and more women than men have it.

The symptoms range from mild to severe. The NHS lists boil-like lumps, blackheads, cysts, scarring and channels in the skin that leak pus. The exact cause is unknown, but the lumps develop as a result of blocked hair follicles. It runs in families in about 1 in 3 cases, and the NHS is clear that it is “not infectious and isn’t linked to poor hygiene.” That matters, because many people with HS carry shame that the condition does not deserve.

The NHS also calls it “a lifelong, recurring condition that is often difficult to manage, although the symptoms may improve or eventually stop with treatment.” Keep that sentence in mind through the rest of this article. Smoking is one factor you can change, but it is not the only one, and HS can occur in people who have never smoked.

Hidradenitis suppurativa and smoking: how strong is the link?

On the NHS page, the wording is direct: “Smoking and obesity are both strongly associated with hidradenitis suppurativa, and if you’re obese and/or smoke it will make your symptoms worse.” Its lifestyle advice for people with HS includes losing weight if you are overweight and stopping smoking if you smoke.

Studies of people with HS point the same way. In a 2026 analysis of 787 patients from the Copenhagen Hidradenitis Suppurativa Cohort, published in the Journal of the European Academy of Dermatology and Venereology, 53.9 percent were current smokers. That is a large share of one clinic population, and it is one reason dermatologists raise smoking early.

The link is not only about adults. A 2026 case-control study at the Mayo Clinic compared 174 patients whose HS was diagnosed before age 18 with 522 matched controls. Active or passive smoke exposure was more common in the HS group, with an odds ratio of 4.8 (95% CI 3.06 to 7.61) for passive and/or active exposure and 1.64 (95% CI 1.01 to 2.61) for passive exposure alone. The authors concluded that smoke exposure increased the odds of having HS. This was a retrospective study at a single center, so it shows an association rather than proof of cause.

One more point worth knowing: a study of 1,689 HS patients, published in Dermatology in 2025, found that the number of affected body sites rose with pack-years smoked, and that smokers reported more pain during flares and a poorer quality of life. Its authors described a dose-response pattern, meaning heavier smoking went with more severe disease.

This Mayo Clinic video gives a general overview of the condition and how clinicians approach it.

Does smoking make flares and treatment worse?

The 2026 Danish analysis looked at disease severity as well as smoking status. Compared with never smokers, and after adjustment, current smokers were more likely to be at Hurley stage III than stage I (odds ratio 2.38, 95% CI 1.02 to 5.56), and they had higher severity scores, worse quality-of-life scores and greater overall disease-related bother. Hurley staging is the scale clinicians use to describe how extensive HS is, with stage III the most severe.

The finding that will matter most to anyone on medication concerned treatment response. Among patients started on tetracycline-class antibiotics, current smokers had a significantly smaller average drop in their IHS4 severity score (2.5 versus 4.7 in non-smokers) at follow-up. In plain words, the same antibiotic appeared to help less in people who were smoking. The authors concluded: “Smoking is associated with greater disease severity, poorer quality of life and worse treatment outcomes among patients with HS.”

All of these are observational. They cannot prove that smoking is the cause of the extra severity, because people who smoke can differ from those who do not in other ways. But the pattern is consistent across countries, ages and study designs, which is why the advice to stop is so common.

Does quitting smoking help HS?

This is the question most readers came for, and the honest answer has two parts.

Quitting and the risk of developing HS

A 2024 population-based cohort study in JAMA Dermatology followed 6,230,189 Korean adults for 84,457,025 person-years, during which 3,761 people developed HS. Compared with people who kept smoking, those who quit between two health checkups had a lower risk of developing HS (adjusted hazard ratio 0.68, 95% CI 0.56 to 0.83). People who stayed quit had a similar reduction (0.67), and never smokers had the lowest (0.57).

The timing detail is useful. In the early period of observation, quitters had a risk similar to continuing smokers. Three to four years after quitting, their rate slowed and came to resemble that of never smokers. And people who quit and then started again, or who took up smoking, had a risk “similar” to sustained smokers. The authors concluded that quitting and staying smoke-free were associated with a reduced risk of HS development.

Quitting once you already have HS

Here the evidence is thinner, and it would be wrong to promise more than exists. The Danish study did include a smaller analysis of people who changed their smoking behavior, and it reported: “Smoking cessation and initiation both showed a trend towards increased self-reported disease severity after 12 months follow-up; however, data were limited.” In short, the data on quitting after diagnosis are limited, and a study this size cannot tell you whether your lumps will settle after you stop.

What can be said fairly is this. The NHS tells people with HS to stop smoking as part of managing it. Smoking is linked to worse severity and less response to antibiotics. Quitting is linked to lower risk of developing HS in the first place. Taken together, stopping is a reasonable step to take alongside medical treatment, but any benefit for existing disease is not guaranteed, and it should not replace the treatment your dermatologist prescribes.

Weight, smoking and HS

The NHS names smoking and obesity together as factors strongly associated with HS, and advises losing weight if you are overweight. Many people try to tackle both at once, and then run into a familiar problem: stopping smoking can come with appetite changes, and worrying about weight can make quitting feel risky.

There is no need to treat these as competing goals. Weight changes after stopping smoking are common, and a dermatologist or GP can help you plan both at a pace that suits you. There is no reliable published figure for how weight and quitting together affect HS, so if this is your situation, raise it directly with your clinician.

If your HS sits alongside other conditions that smoking affects, our guides on smoking and psoriasis quitting effects and smoking Crohn’s disease quitting benefits cover related ground. The NHS notes that HS may, in rare cases, be linked to Crohn’s disease, particularly when it develops around the groin and the skin near the anus.

Quitting with a chronic skin condition

Living with a painful, relapsing condition makes quitting harder in a practical way. Flares bring pain, poor sleep and low mood, and the NHS acknowledges that HS can affect quality of life and lead to depression. Cigarettes often become part of coping. If that sounds like you, you are not weak; you have a real reason the habit is sticky, and a real reason to build a plan around it.

• Tell your dermatologist. They can note your smoking status in your treatment plan and point you to local stop-smoking support.
• Do not stop treatment to quit. Keep taking prescribed medicines. Quitting is an addition to treatment, not a replacement.
• Plan for flare days. Decide in advance what you will do instead of smoking when pain or stress spikes, such as holding a warm washcloth on the lumps (the NHS suggests this to encourage the pus to drain), a walk or a call to a friend.
• Expect lapses. A slip does not erase your progress. Note what triggered it and adjust the plan.
• Ask about stop-smoking medicines. Nicotine replacement and other options are available through your GP or pharmacist; our best NRT options compared guide explains the choices.

The free iQuit app can support the quitting side of this. It lets you choose cold turkey or gradual reduction, log cravings with their triggers, keep a mood journal to spot stress-linked patterns, use SOS tools when an urge hits, and watch smoke-free days and money saved build up. It does not treat or manage hidradenitis suppurativa, so it works alongside your dermatologist and never in place of them. You can compare it with other tools in our best quit smoking apps feature comparison rankings.

What else changes for your skin when you stop

Beyond HS, stopping smoking changes many things in the body over time. For the broader picture, read our skin health recovery timeline and the what happens when you quit smoking complete health recovery guide. Neither promises that HS will clear, and neither should be read that way. Think of quitting as removing one of several things that can push the condition in the wrong direction, while diagnosis, medicines and, where needed, surgery stay in your dermatologist’s hands.

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