HS nd pregnancy

Managing Hidradenitis Suppurativa in Pregnancy Tori Rodriguez, MA, LPC | May 1, 2026 Significantly more women than men develop hidradenitis suppurativa (HS), with a majority of cases occurring among patients of reproductive age. 1 Pregnancy and the postpartum period presents additional challenges in the management of patients with HS due to associated adverse events and increased complexity of therapeutic regimens. Research exploring the relationship between HS, pregnancy, and the post-partum period has begun to gain momentum. Studies have emerged examining HS and associated maternal and fetal outcomes, guidelines were developed on treatments specific to pregnant and breastfeeding patients, and more attention has been given to patient desires for family planning than ever before. Recent Findings on Pregnancy Outcomes in HS Across numerous studies, HS has been linked to a range of adverse events in both pregnancy and childbirth. “Pregnant mothers with HS are at higher risk for hypertension, gestational diabetes, cesarean delivery, severe maternal morbidity, preterm birth, and birth defects compared with those without HS,” explained Chris Adigun, MD, founder of the Dermatology and Laser Center of Chapel Hill. 1 https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 1 of 6“ Given how common this condition is and the significant impact it has on pregnancy and neonatal outcomes, there is a need for further research and ” investigation. A population-based longitudinal study published in 2024 found an increased risk for the following outcomes among patients with HS compared with patients without HS: Severe maternal morbidity (risk ratio [RR], 1.38; 95% CI, 1.03-1.84); Hypertensive disorders of pregnancy (RR, 1.55; 95% CI, 1.29-1.87); Gestational diabetes (RR, 1.61; 95% CI, 1.40-1.85); and Long-term risk for hospitalization (RR, 2.29; 95% CI, 2.07-2.55). 1 Among birth outcomes, an increased risk for preterm birth (RR, 1.28; 95% CI, 1.07-1.53) and cesarean delivery (RR, 1.18; 95% CI, 1.07-1.30) were noted among patients with HS. The children of mothers with HS had an increased risk for birth defects (RR, 1.29; 95% CI, 1.07-1.56) and long-term risk for childhood hospitalization (RR, 1.31; 95% CI, 1.18- 1.45). 1 The odds of a spontaneous abortion (14%), ectopic pregnancy (73.2%), therapeutic abortion (52.9%), and stillbirth (76.2%) compared with a live birth were significantly greater in patients with HS, according to analyses of a 2025 retrospective study. 2 Retrospective studies published in 2022 also observed heightened risks in many of these maternal and obstetric outcomes. 3,4 “However, a limitation of these studies is the lack of data regarding whether pregnancy outcomes may be influenced by HS disease severity or whether a patient’s HS disease is well-controlled,” noted Jennifer Hsiao, MD, clinical associate professor of dermatology and director of the Hidradenitis Suppurativa Specialty Clinic at Keck Medicine of the University of Southern California. https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 2 of 6Regarding HS outcomes, studies have demonstrated that while 24% of patients with HS reported symptom improvement during pregnancy, 20% reported worsening symptoms in pregnancy and 60% reported postpartum disease flares. 5 In a large French study published in 2025, a substantial number of women with HS indicated impairment in multiple areas of sexual functioning, and more than one- third reported that they had hesitated or decided not to have a child because of their HS. 7 Recommendations on HS Treatment During Pregnancy Several papers have discussed clinical insights and treatment considerations for patients with HS who are pregnant or breastfeeding. 5,7-9 While some therapies have adequate literature available to support their use in pregnant and breastfeeding patients, other typical HS therapies are contraindicated, and others still need further exploration. “It is important for women with HS to know that HS can still be treated while they are planning pregnancy and also when they are pregnant,” Dr Hsiao emphasized. “In addition, many patients with HS may automatically self-discontinue all medications when they find out they are pregnant,” Dr Hsiao added, which underscores the need for patient education and counseling on this topic prior to pregnancy. Managing HS in pregnancy requires consideration of potential risks to both the patient and the fetus. “Topical options, like prescription clindamycin lotion or benzoyl peroxide washes at low concentrations, are considered safe and are often used as first-line therapy,” said Marisa Garshick, MD, dermatologist at MDCS Dermatology: Medical Dermatology & Cosmetic Surgery and clinical assistant professor of dermatology at Weill Cornell Medicine. 9 “If systemic treatment is required, antibiotics such as clindamycin or cephalexin are generally preferred, but tetracyclines like doxycycline should be avoided,” Dr Garshick continued. https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 3 of 6Systemic retinoids and most hormonal therapies are also contraindicated during pregnancy due to fetal risks, Dr Adigun added. 9 “In terms of biologic therapy for HS during pregnancy, tumor necrosis factor-alpha antagonists have the most data supporting their safety, but there is increasing data for interleukin-17 inhibitors,” Dr Hsiao stated. 9 “ Contributing to pregnancy exposure registries will help improve our understanding regarding safety of biologics in pregnancy.” “There is also emerging evidence that using metformin is both safe and efficacious for HS during pregnancy,” Dr Adigun said. 9 “Procedures for HS flares, including intralesional steroid injections and incision and drainage of abscesses, may still be performed, though it is generally recommended to hold off on large HS excisions during pregnancy, if possible,” according to Dr Hsiao. 9 Dr Garshick highlighted the need for a multidisciplinary approach in the treatment of pregnant and postpartum patients, which should include collaboration with obstetricians and maternal-fetal medicine colleagues as needed. Additionally, “Optimizing comorbidities such as smoking cessation and glucose control can improve outcomes both for pregnancy and HS.” Dr Garshick further noted the importance of planning ahead with patients for safe, effective therapies after delivery and during breastfeeding, given the high prevalence of postpartum flares. A small survey-based study found that 83% of women with HS had not received guidance from their physician regarding the potential impact of HS and HS therapies on pregnancy outcomes. 10 “Open and ongoing conversations with patients about their goals for family planning and disease management are essential so that treatments may be adjusted if needed,” Dr Garshick advised. Remaining Gaps https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 4 of 6To improve outcomes in this patient population, additional research and education are warranted. Dr Hsiao pointed to the need for prospective studies that include data on HS disease course, severity, and treatment patterns during pregnancy, as well as the influence of these factors on maternal and neonatal outcomes in patients with HS. “There is definitely a gap in evidence regarding both safety and efficacy of new therapies for HS in pregnant and lactating women,” Dr Adigun said. “Given how common this condition is and the significant impact it has on pregnancy and neonatal outcomes, there is a need for further research and investigation.” “ One of the biggest challenges is the limited data on how to best manage HS during pregnancy,” according to Dr Garshick. She also cited the need for increased education of both patients and providers and greater collaboration between clinicians. “Education is key, as many patients and even some providers may not be aware of how HS can impact pregnancy outcomes, so increasing awareness could help with earlier intervention and better counseling,” Dr Garshick said. “Ultimately, more collaboration between dermatology, obstetricians, and primary care clinicians would help ensure patients receive comprehensive care throughout pregnancy and beyond.” References: 1. 2. 3. Li K, Piguet V, Croitoru D, et al. Hidradenitis suppurativa and maternal and offspring outcomes. JAMA Dermatol . 2024;160(12):1297-1303. doi:10.1001/jamadermatol.2024.3584 Walsh DP. Pregnancy outcomes in hidradenitis suppurativa patients. AMIA Annu Symp Proc . 2025;2024:1169-1175. PMID:40417565 Fitzpatrick L, Hsiao J, Tannenbaum R, Strunk A, Garg A. Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa. J Am Acad Dermatol . 2022;86(1):46-54. doi:10.1016/j.jaad.2021.06.023 https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 5 of 64. 5. 6. 7. 8. 9. 10. Sakya SM, Hallan DR, Maczuga SA, Kirby JS. Outcomes of pregnancy and childbirth in women with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86(1):61-67. doi:10.1016/j.jaad.2021.05.059 Seivright JR, Villa NM, Grogan T, et al. Impact of pregnancy on hidradenitis suppurativa disease course: a systematic review and meta-analysis. 2022;238(2):260-266. doi: 10.1159/000517283. Özbek L, Güldan M, Alpsoy E, Vural S. Hidradenitis suppurativa treatment during pregnancy and lactation: navigating challenges. Int J Dermatol. 2025;64(7):1173-1185. doi:10.1111/ijd.17672 Fite C, Taieb C, Nassif A, et al. High sexual impact of hidradenitis suppurativa in women with more than one-third of patients renouncing a desire for pregnancy: Results of a nationwide study in France. Clin Exp Dermatol. 2025;50(8):1647-1649. doi:10.1093/ced/llaf116 Chung CS, Park SE, Hsiao JL, Lee KH. A review of hidradenitis suppurativa in special populations: Considerations in children, pregnant and breastfeeding women, and the elderly. Dermatol Ther (Heidelb) . 2024;14(9):2407-2425. doi:10.1007/s13555-024-01249-2 Ghanshani R, Lee K, Crew AB, Shi VY, Hsiao JL. A guide to the management of hidradenitis suppurativa in pregnancy and lactation. Am J Clin Dermatol. 2025;26(3):345-360. doi:10.1007/s40257-025-00935-x Adelekun AA, Villa NM, Hsiao JL, Micheletti RG. Pregnancy in hidradenitis suppurativa – patient perspectives and practice gaps. JAMA Dermatol. 2021;157(2):227-229. doi:10.1001/jamadermatol.2020.5162 Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.