How should Pregnant and Nursing Mothers manage Hidradenitis Suppurativa?

February 28, 2021

Andrew S. Kao, Wayne State University School of Medicine

What treatments are safe for HS patients during pregnancy and breastfeeding?

For safety, research studies usually don’t include pregnant and nursing patients, so most of our knowledge about the treatment of Hidradenitis suppurativa (HS) is based on non-pregnant and non-nursing patients. With a growing need to properly manage HS in pregnant and nursing mothers, here we discuss the article “Management of Hidradenitis Suppurativa in Pregnancy” published in 2017 that provides the most up-to-date information. However, it is important to speak with your healthcare provider prior to starting any treatment.

Over 140 medical articles were reviewed…

The authors reviewed 143 articles to create a comprehensive list of treatment options available for both pregnant and nursing mothers. They kept track of safety and effectiveness when examining current medications, surgery, and lifestyle choices specifically for treating HS during pregnancy and breastfeeding.

Some medications are safe for HS in pregnancy

Topical (meaning applied to the skin) antibiotics (clindamycin, erythromycin, metronidazole) are the first choice to treat HS for pregnant and nursing mothers. Besides lotion and creams, alcohol-based formulations (gel and solution) are particularly useful as they dry easily after application. Little to none of these antibiotics get into breast milk, making them safe for nursing mothers.

For moderate to severe HS patients, the oral antibiotic combination of clindamycin and rifampin is the first choice for treatment. Rifampin can interact with other medications, which must be checked before starting it. Dapsone is another antibiotic safe for both pregnant and nursing mothers. Metformin, an oral medication used to treat diabetes, was mildly effective for HS without side effects in both pregnant and nursing mothers. Biologics, like adalimumab and infliximab, are antibodies used to treat HS. They are considered safe during pregnancy and lactation and are sometimes stopped during the third trimester to avoid transferring the antibodies to the baby.

To manage pain, acetaminophen is the best choice in pregnancy and the nursing period.  Aspirin, ibuprofen, and naproxen can cause problems for the baby and should be avoided during pregnancy.  Ibuprofen is safe to take while breastfeeding.  Prescription pain medications should also be avoided since they affect the baby. One prescription pain medication, tramadol, is considered safe during breastfeeding for severe pain.

When surgery is unavoidable

Surgery should generally be avoided in pregnancy. However when medications don’t work well enough, excisional surgery (removing areas of skin affected by HS) is a safe choice for pregnant and nursing populations. Cryoinsufflation is a simple and fast procedure that can be done in the office.  It uses extreme cold (liquid nitrogen) to freeze the HS tunnels in the affected skin, and they resolve after several treatments.

Lifestyle choices that make a huge difference

Smoking increases risk for potential birth defects in babies and can worsen HS symptoms for mothers. Pregnant and nursing patients are strongly encouraged to quit or switch to gum that has lower nicotine content. Additionally, being overweight increases the risk of friction and irritation. Proper diet and weight management are important to reduce HS symptoms and promote good health overall.

Taking bleach baths (a bath with a tiny amount of chlorine bleach, similar to swimming pool chlorine) can reduce odor. Wound dressings can prevent clothes from staining. Lastly, mental health wellness is important as HS is a difficult disease, and patients often experience symptoms of depression. During pregnancy, that can take an additional emotional toll.  Support groups and counseling can be very helpful, especially for pregnant patient and nursing mothers.

Paper Citation: Perng P, Zampella JG, Okoye GA. Management of hidradenitis suppurativa in pregnancy. J Am Acad Dermatol. 2017 May;76(5):979-989.