Associations of Active and Passive Smoke Exposure and Hidradenitis Suppurativa in the Pediatric Population: A Case–Control Study

BACKGROUND: Hidradenitis suppurativa (HS) is an inflammatory condition associated with cysts of the folliculopilosebaceous unit primarily affecting intertriginous areas. HS has been correlated with smoke exposure in the adult population, but there is a knowledge gap in understanding its effect in pediatric and adolescent patients. This study assesses correlations between active and passive smoke exposure and the development of HS in the pediatric and adolescent population. METHODS: A retrospective case-control study was conducted at Mayo Clinic (2010-2023) of patients diagnosed with HS before the age of 18 years who were age-, sex-, and race-matched to healthy controls in a 1:3 ratio, analyzed using Fisher exact for categorical variables and Kruskal-Wallis for continuous. RESULTS: One hundred and seventy-four cases and 522 controls met inclusion criteria. The prevalence of active and passive smoke exposure was significantly higher in patients with HS compared to controls (p = 0.001), with passive smoke accounting for 64.6% (N = 31/48) of smoke exposure in patients with HS. Smoke exposure was associated with a significant increase in the odds of an HS diagnosis, with an odds ratio of 4.8 (95% CI: 3.06-7.61) for passive and/or active exposure, and 1.64 (95% CI: 1.01-2.61) for passive exposure alone. Smoke exposure was associated with a later age of diagnosis than those with no smoke exposure (p < 0.001). CONCLUSION: Prevalence of active and passive smoke exposure was higher in pediatric and adolescent patients with HS compared to age, sex, and race-matched healthy controls. Smoke exposure increased the odds of having HS and was associated with a later age at diagnosis.