Key takeaways

• Smoking is strongly associated with HS and more severe disease. Research has linked smoking to an increased likelihood of developing hidradenitis suppurativa (HS), greater disease severity, and potentially reduced responses to certain treatments.

• Quitting smoking is recommended as part of HS management. Studies suggest that quitting may lower the risk of developing HS, although evidence about its effect on existing disease is more limited.

• Alcohol may trigger flares in some patients, but research is less conclusive. Tracking your symptoms can help identify whether drinking affects your HS.

• Alcohol can interact with certain medications. If you're receiving treatment for HS, check with your dermatologist or pharmacist about potential interactions.

• Lifestyle changes complement, rather than replace, medical treatment. A dermatologist experienced in HS can help you develop a comprehensive plan to manage inflammation and prevent disease progression.

Smoking and alcohol are two lifestyle factors that may influence hidradenitis suppurativa (HS), a chronic inflammatory skin condition that causes painful, recurring lumps, abscesses, and sometimes scarring.

Research has established a strong association between smoking and HS, including links to more severe disease. The relationship between alcohol and HS is less clear, although some patients report flare-ups after drinking.

Understanding what the evidence shows can help you make informed decisions about your health. While lifestyle changes may support symptom management, HS is a medical condition that often requires ongoing treatment from a dermatologist.

Smoking is one of the strongest lifestyle links to HS

Smoking is one of the most extensively studied lifestyle factors associated with HS.

Research consistently shows that smoking is more common among people with HS than among those without the condition. However, these findings are largely observational, meaning they demonstrate an association rather than proving that smoking directly causes HS.

How closely smoking and HS are tied

Smoking is far more common in people with HS than in people without it. In a pooled analysis of 20 studies, people who currently smoke had about four times the odds of having HS (odds ratio 4.26).

This is a substantial association, but it does not mean smoking is the sole cause of HS.

HS is a complex inflammatory condition influenced by several factors, including genetics, immune activity, and hormones. Smoking is one potentially modifiable risk factor.

Recurring painful lumps in areas such as the armpits, groin, or buttocks should be evaluated by a dermatologist, regardless of smoking history. These symptoms may indicate HS rather than ordinary boils.

Smoking and more severe disease

Dermatologists describe HS severity with Hurley stages. Stage I means occasional lumps, stage II means recurring lumps with some tunnels and scarring, and stage III means widespread connected tunnels and scarring.

In a 2026 study of 787 patients at a Danish hospital, current smokers were more likely than never-smokers to have stage III (odds ratio 2.38). They also reported worse quality of life.

Although these findings suggest an important relationship between smoking and disease severity, the study does not establish that smoking directly caused more advanced HS.

Can Smoking Affect HS Treatment Response?

Smoking may also influence how well certain HS treatments work.

Oral antibiotics, including tetracycline-class medications such as doxycycline, are commonly used to help manage HS inflammation.

In the same Danish study, researchers evaluated changes in disease severity among patients receiving tetracycline-class antibiotics.

Improvement was measured using the International Hidradenitis Suppurativa Severity Score System (IHS4), which accounts for inflammatory nodules, abscesses, and draining tunnels.

Researchers observed that:

• Current smokers experienced an average IHS4 reduction of approximately 2.5 points.

• Nonsmokers experienced an average reduction of approximately 4.7 points.

These findings suggest that current smokers experienced less improvement during treatment with tetracycline-class antibiotics.

However, the study does not establish that smoking caused the difference in treatment response, and its findings should not be generalized to all HS medications.

Your dermatologist can consider smoking history alongside disease severity, previous treatment responses, and other factors when developing your treatment plan.

What quitting smoking does for HS

Leading dermatology guidelines include quitting as part of HS care. The AAD hidradenitis suppurativa guideline makes a conditional recommendation in favor of tobacco cessation, alongside supportive pain management, zinc, and vitamin D. A conditional recommendation is one based on the best available evidence, which is still limited.

A large study of about 6.2 million adults looked at whether people who quit went on to develop HS. In a JAMA Dermatology cohort study, quitters had about a one-third lower risk of developing HS than people who kept smoking (adjusted hazard ratio 0.68). People who started smoking again lost that benefit.

These numbers describe developing HS in people who did not yet have it. Whether quitting improves HS that is already active has not been firmly measured.

Dermatologists still recommend quitting for people living with HS, for three reasons:

• Smoking is linked to more severe stages of HS.

• Smoking is linked to a smaller response to common first-line antibiotics.

• Quitting brings broad health benefits beyond the skin.

Alcohol and HS: a less certain, more individual link

Alcohol may make HS worse for some people, but research has not measured it the way it has for smoking. Treat alcohol as a possible personal trigger to watch rather than an established cause.

The comparison below shows where the two habits stand.

What is known about alcohol and flares

According to the Canadian Dermatology Association, "some people with HS find that alcohol promotes a flare of their disease." This reflects what patients notice, not a measured effect. It is still useful, because HS triggers vary from person to person.

A short flare diary is a simple way to check your own pattern. For 6 to 8 weeks, log your drinks per week and any new or worsening lumps. Then review it with your dermatologist.

This is a practical suggestion, not a research-tested method. One flare after drinking does not show a pattern, but several weeks of notes give you and your dermatologist something concrete to discuss.

Alcohol and the medicines used for HS

Alcohol can also affect medicines. A National Institute on Alcohol Abuse and Alcoholism (NIAAA) guide to alcohol and medicine interactions says alcohol can make some medicines less effective or harmful.

Medicines on the NIAAA list include:

• Metronidazole, an antibiotic sometimes used in HS combinations

• Ibuprofen and naproxen, common over-the-counter pain relievers

• Acetaminophen, another over-the-counter pain reliever

• Opioid pain medicines, available by prescription

NIAAA notes that its list is not complete. Ask your pharmacist or dermatologist about alcohol with each medicine you take, including any new prescription.

Why this matters for men with HS

HS affects men too, and it can look different. In a UCLA study of 209 patients, 69 of whom were men, men were more often active smokers than women (28% vs. 12%).

Men in that clinic also more often had HS on the buttocks, including around the anus (52% vs. 25%). They had 2.24 times the risk of presenting at Hurley stage III. These findings come from a single clinic, so they may not apply to every man with HS.

For men who smoke, quitting is one of the most concrete changes available. HS in intimate areas also deserves a private visit with a specialist who treats it often. For symptoms and common locations, see our guide to how HS shows up in men.

Practical steps for quitting or cutting back

These steps are built around HS care. Each one comes with its reason.

• Tell your dermatologist you smoke or drink, so the plan accounts for it and for how treatment may respond.

• Ask about quit-smoking medicines and support before trying another nicotine product, since choosing a quit aid is a decision for your doctor and you.

• Set a quit date and plan for stressful moments and flare days, when cravings may rise.

• Track drinks and flares together for a few weeks to see whether alcohol is a personal trigger.

• Expect slips and restart quickly, because staying quit is what the research linked to lower risk.

• Keep your treatment going while you change habits, because the two work together.

Lifestyle changes work alongside treatment

Habits shape the background of HS, and medical treatment controls the inflammation. Dermatologists choose among several medical treatments for HS based on stage, location, and how the disease has responded so far.

Common options include:

• Topical treatments applied to the skin

• Oral antibiotics, often from the tetracycline class

• Hormonal therapy

• Steroid injections into painful lumps

• FDA-approved biologics for moderate to severe HS

• Procedures to drain lumps or remove tunnels and scarred skin

See a dermatologist if you notice any of the following:

• Lumps that keep returning in the same spots

• Lumps that drain, tunnel, or scar

• Flares that continue despite antibiotics or habit changes

• Pain that affects work, sleep, or sex

If you have not been diagnosed, our guide to boils that keep coming back explains what recurring lumps can mean and who to see.

Seeing an HS specialist

Tono's hidradenitis suppurativa program cares for people at every stage of HS. Every visit is led by a specialist.

Visits happen by private video, and you can share photos ahead of time. When you need an in-person exam, labs, or a procedure, your care team coordinates it.

Appointments are available in 2 days or less. No referral is needed with most plans, and most insurance is accepted. You can review insurance and referral details before booking.

Tono has cared for more than 20,000 patients across 33 states. Prescriptions go to your local pharmacy, and your specialist manages biologics over time as your needs change. Among HS patients, Tono's Net Promoter Score, a standard measure of patient loyalty, is 84.

Your specialist can build quitting and alcohol decisions into your treatment plan. Care continues after the first visit, so Tono becomes your ongoing specialty medical home for HS. To learn more about the care model, read why virtual-first HS care works.

Frequently asked questions

Can quitting smoking make HS go away?

No single change makes HS go away. Quitting is recommended as part of HS care, and medical treatment is what controls the disease.

Is smoking the cause of my HS?

Smoking is one of the strongest risk factors for HS, but not the only one. HS also involves genes, hormones, and immune activity.

Is it safe to drink while taking antibiotics for HS?

It depends on the medicine. NIAAA lists metronidazole, an antibiotic sometimes used for HS, among medicines that interact with alcohol. Ask your pharmacist about each prescription.

Does the type of alcohol matter for HS?

There is no reliable evidence that one type of drink is safer for HS than another. Tracking your own pattern with your dermatologist is the most useful step.

What kind of doctor treats HS?

A dermatologist treats HS, ideally one with specific HS experience.

The habits you can change matter most when they sit inside a plan built with a specialist who knows HS. Schedule an in-person or virtual appointment with a Tono Health specialist.

This article is for educational purposes and is not a substitute for medical advice.