PONE-D-24-40744Hidradenitis suppurativa (HS) in diabetes mellitus patients: A link between alterations in smoking intensity and the risk of developing HSPLOS ONE

Dear Dr. Lee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

Reviewer #4: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:  Thank you for inviting me to review this paper. The authors have investigated the association of alterations in smoking intensity and the risk of developing HS in patients with DM. Overall, the association of smoking and HS has been previously studied. Thus, the topic is not a novel one. However, the finding regarding BMI is interesting. The method section needs to be improved as it requires more detail.

My comments are the followings:

-line 39: compared to which population?

-line 40: please clarify that you are discussing smoking.

-line 47: which year?

-did the authors exclude patients using anti-diabetic medications for reasons other than DM?

-add more details on blood sample collection and measurement methods.

-add more details on height and weight measurement for BMI calculation.

-cite the reference associated with physical activity categories.

- line 165: which figure? also add numerical values.

- mention the observational nature of the study as limitation for finding causation.

-define abbreviations below the tables.

-what is the possible explanation for finding no association after BMI stratification?

Reviewer #2:  It is suggested that the manuscript should replace instances of "we" or "our" with phrases such as "current study," "this study," or "present study" to minimize repetition.

The rationale of the study should be clearly stated at the end of the introduction.

Extensive proofreading and rephrasing are essential.

The discussion should be more concise and include more references for better comparison with previous research.

Substantial paraphrasing and thorough proofreading are necessary.

The manuscript has low quality. It did not address any specific gap they intended to fill. Furthermore, it does not add anything to the subject area compared with other published Material. Therefore, any comments regarding the methodology are equivocal. This manuscript does not fulfill the standards established for the journal to be considered for publication.

Reviewer #3:  1. Conclusion: "This study found an association between smoking and the risk of HS, with implications for targeted interventions and smoking cessation strategies in at-risk populations". The conclusion should be less related to the target group of the study (diabetics).

Results:

2. Please provide a flow diagram and report numbers of individuals at each stage of study—eg numbers potentially eligible and give reasons for non-participation at each stage.

3. Can medication for diabetes affect the association of Smoking on HS? Is this not examined in this study?

4. The median/mean follow-up time should be mentioned

5. In the title of the first table, you must also specify the smoking status as in the second table.

6. In Table 3-4, the p value should be reported according to the number of risk ratio estimates (n=6 estimations) in last column.

7. In table 4, you can also do the trend test

Reviewer #4:  Suggested title- A link between smoking behaviours and the risk of Hidradenitis Suppurative in diabetic patients

Abstract-is too simplified and does not explore why the team wanted to study HS in DM and link with smoking.

Intro-intro talks more about HS-DM cause-effect relationship and touched only abit about smoking & HS

- line 63: Two meta-analyses found a 1.69–3.00 fold increase in the odds of DM in HS populations [10, 23, 24]. (added fold)

- line 68: Therefore, we aimed to investigate the effects of changes in smoking on the risk of HS in patients with DM using a large-scale, nationally-representative claims database in Korea. (fragmented sentence, suggest revise)

- the link between DM-Smoking-HS remains elusive and why this is the focus of the study is still unclear from the literature reviews done.

Materials & methods:

- need proofreading by a native speaker who are familiar with health related research manuscript.

- some confounding factors not explored: anti-inflammatory medication, surgical procedures, other medications/ treatment for HS, and diabetic control (HBA1c levels) need to be mentioned.

- Definition of smoking intensity change :suggest to change to definition of a change in smoking intensity

- Definition of never, former and current smokers were unclear, reducers, sustainers, increasers and starters? These definition may be better presented in a table. Would be good to get this presented as part of an experimental design flowchart (as a figure)

line 126: All blood samples were taken during fasting

Results

- line: 145 The cohort comprised of 1,705,427 participants (581,618 males [34.1%], 1,123,809 females [65.9%]; mean [SD] age, 59.03 [11.76] years). (added of)

- line 165: Kaplan-Meier estimates showed that the incidence of HS was higher in increasers than in quitters. (Figure) (which figure? Each figure should have a number assigned)

Discussion

- Minor proofreading help with grammar such as putting connectors where appropriate

- Would be good to discuss the effects of polyaromatic carbohydrates and nicotine in HS development to better link tobacco smoking and HS

- Would like to suggest the authors to refrain from using first-person language in the discussion to keep the discussion more impersonal.

- Limitation: HS treatment can be many, and over the course of 2 years, participants may have taken multiple medications to prevent or treat the disease which may lead to bias in the findings. Medication data was not available and should be mentioned in the limitation.

Tables and figures:

- suggest to refer to "figure" as "figure 1"

- suggest to increase figure 1 image quality to 300 dpi

- suggest to include experimental design flowchart in the form of a figure

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Reviewer #1: No

Reviewer #2: Yes:  Shooka Mohammadi

Reviewer #3: No

Reviewer #4: Yes:  Intan Suhana Zulkafli

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PONE-D-24-40744R1A link between smoking behaviors and the risk of Hidradenitis Suppurativa in diabetic patientsPLOS ONE

Dear Dr. Lee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The revised manuscript is re-evaluated by the previous reviewers. Please address reviewers' remaining concerns.

Please submit your revised manuscript by May 18 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Jianhong Zhou

Staff Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: -Add reference for the Korean Association of Laboratory Quality Control guidelines.

-Please add the possible explanation for finding no association after BMI stratification to the discussion section as well.

Reviewer #2: The manuscript has low quality. It failed to meet the established standards required for consideration in the journal.

Reviewer #3: Dear editor,

All comment have been addressed by authors, My Final Decision is ACCEPTANCE.

Best Regards,

Cheraghi

Reviewer #4: The authors have addressed all the comments from all reviewers satisfactorily. The authors responded to each individual suggestions with good explanation supplemented by figures. These have improved the manuscript significantly.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes:  INTAN SUHANA ZULKAFLI

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

A link between smoking behaviors and the risk of Hidradenitis Suppurativa in diabetic patients

PONE-D-24-40744R2

Dear Dr. Lee,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Emanuele Scala

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: No

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: No

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: The manuscript has low quality. It failed to meet the established standards required for consideration in the journal.

Reviewer #4: Abstract: massive improvement, well written with clear direction

Introduction: very well-written and edited

Methods:

overall the methodologies section is well written & edited with sound methodologies use

Line 109 is unclear/ hanging: Anti-diabetic medications included insulin, metformin, sulfonylureas, meglitinides, dipeptidyl peptidase 4 (DPP-4) inhibitors, thiazolidinediones, and α-glucosidase inhibitors.

Suggest change to:

Anti-diabetic medications included were insulin, metformin, sulfonylureas, meglitinides, dipeptidyl peptidase 4 (DPP-4) inhibitors, thiazolidinediones, and α-glucosidase inhibitors.

Results:

adequately written

Discussion:

comprehensively discussed

tables and images are in good quality

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

Reviewer #4: Yes:  INTAN SUHANA ZULKAFLI

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