The relationship between tobacco use and hidradenitis suppurativa (HS) is controversial. To determine incidence of HS among tobacco smokers. Retrospective cohort analysis identifying incident HS cases among adult tobacco smokers and non-smokers sampled from a demographically heterogeneous population-based sample of over 50 million unique patients across all census regions. We identified 3,924,310 tobacco smokers, among whom were 7,860 patients newly diagnosed with HS.