Hidradenitis Suppurativa: Higher Tobacco Pack-Years in Patients with Metabolic Comorbidities

<b>Background</b>: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory dermatosis with substantial quality-of-life impact. HS frequently co-exists with obesity and metabolic comorbidities. Cigarette smoking is highly prevalent and has been linked to heightened inflammatory activity and impaired wound healing. The role of cumulative tobacco exposure (packyears) in relation to metabolic comorbidities in HS is less well defined. We therefore investigated whether lifetime pack-years relate to laboratory parameters and the presence of comorbidities in HS. <b>Methods</b>: We conducted a retrospective, single-center study involving 131 patients with HS. We collected clinical data, including disease severity scores and quality of life indices, along with laboratory markers such as complete blood count and C-reactive protein. Smoking status and cumulative exposure (pack-years) were assessed based on patient history. To compare laboratory parameters between smoking subgroups, we used Mann-Whitney U tests. Additionally, we performed logistic regression analyses to evaluate the association between cumulative cigarette exposure and the presence of comorbidities. <b>Results</b>: Among the cohort, 63.4% were active smokers with a median of 15 pack-years. Smokers had significantly higher leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts, indicating elevated systemic inflammation. Hematocrit, hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin were also significantly higher in smokers, while C-reactive protein levels did not differ notably between groups. Subgroup analysis revealed that patients with arterial hypertension, diabetes mellitus, and hypercholesterolemia had significantly more pack-years than those without these conditions. These comorbidities, components of metabolic syndrome, were strongly associated with higher lifetime tobacco exposure in HS patients. <b>Conclusions</b>: Smoking contributes not only to heightened inflammatory activity in HS but is also significantly associated with the presence of metabolic comorbidities. These findings underscore the importance of early interdisciplinary intervention and structured smoking cessation programs to improve outcomes in HS patients.