Hidradenitis Suppurativa during Pregnancy


Hidradenitis Suppurativa during Pregnancy

Hidradenitis suppurative (HS) is difficult to treat in the general patient population and can have fatal consequences in pregnant patients. According to the findings of a new study1, pregnant patients with HS are more likely to experience obstetric and pregnancy difficulties, including a decreased chance of having live birth, which emphasises the importance of aggressively managing this condition. Recurrent painful nodules, abscesses, draining cutaneous fistula tracts, and scarring are the hallmarks of HS, which also tend to affect intertriginous areas such as the axillae, and groyne, gluteal, and submammary regions. It may have a major impact on a patient's quality of life. In more severe cases, comorbidities such as metabolic syndrome, follicular occlusion issues, inflammatory bowel conditions including Crohn's disease, and spondyloarthropathy may also be present.

According to Lyons et al, women who are of childbearing age are disproportionately affected by HS. 2 However, even though the literature has investigated the impact of pregnancy on the clinical course of HS, nothing is known about how HS affects pregnancy outcomes. 2

"Pregnant patients with HS can also have a higher rate of pregnancy complications," said Joslyn Sciacca Kirby, MD, MS, MEd, an associate professor in the Department of Dermatology at Penn State College of Medicine, Pennsylvania State University in Hershey. "Similar to the increased risks of pregnancy seen in female patients with psoriasis, rheumatoid arthritis, systemic lupus erythematosus, s "We dermatologists have a chance to approach all of our patients holistically in this situation. Although they might not be expecting at the time of the visit, they might be considering becoming pregnant, and further information might be helpful.


In a recent study1, Kirby and colleagues looked into the treatment practises and maternal and obstetric outcomes among women with HS. The researchers identified a cohort of 998 pregnant women with HS and a cohort of 5065 age-matched pregnant women without HS using the IBM MarketScan Commercial Claims and Encounters Database. Data from a retrospective analysis on diagnosis, treatments, and procedures were examined.

Live birth, ectopic/molar pregnancy, deliberate termination, spontaneous abortion, indeterminate abortion, and stillbirth were the six categories into which pregnancies were divided. Pregnancy problems, including vaginal and caesarean delivery and therapies, were only assessed in women who had live deliveries. Overweight/obesity, anxiety, and depression were the three comorbidities that were most prevalent in both the HS and non-HS cohorts.

The investigators discovered that pregnant women with HS had significantly higher odds of elective terminations (OR, 2.51; 95 per cent CI, 2.13-2.96), and caesarean deliveries (OR, 1.28; 95 per cent CI, 1.06-1.55), or gestational hypertension compared to women without HS. They also had significantly lower odds of having live birth (OR, 0.45; 95 per cent CI, 0.39-0.51) and significantly lower odds of having gestational hypertension (OR, 1.44; 95 per cent CI, 1.12-1.84). 2

A recent retrospective cohort study2 by Lyons et al. indicated greater probabilities of having a caesarean delivery after controlling for covariates, which is a considerable departure from the data presented here. However, the findings that preeclampsia/eclampsia and pregnant hypertension were proportionally more common in women with HS confirmed the Lyons study's findings.


According to Kirby, pregnant individuals are more prone to experience an HS symptom flare-up. She recommended medical professionals keep an eye out for these flare-ups as well as to inform expecting mothers about symptoms like itchy or painful bumps, which are typically seen in the armpits, groyne, under the breasts, or in the anal and vaginal areas and may be signs of an impending eruption. She advised doctors to talk to pregnant patients who had HS disease about postpartum symptom control therapy.

Given that hormonal acne, polycystic ovarian syndrome, and changes in HS disease severity correlated with the menstrual cycle, hormone dysfunctions are thought to have a role in the underlying pathogenesis, progression, and chronicity of HS.

One-third of patients get better, one-third stay the same, and one-third get worse, according to an old guideline for pregnancy and what to expect from skin disorders, Kirby said. This is also partially true for people with HS because it appears that one-third of women who become pregnant experience an improvement in their HS. Of the remaining two-thirds of patients, more, though, risk getting worse rather than staying the same.

Additionally, researchers discovered that pregnant women with HS used more topical and oral antibiotics and had more cutaneous operations than pregnant women without HS. This discovery, according to Kirby, reflects the reality that patients with HS frequently receive many prescriptions and might need a higher level of care.


In the environment of pregnancy, remedial opinions for HS come more delicate. According to Kirby, she requests that cases inform her as soon as they come apprehensive that they're pregnant so that the two of them can unite on creating the ideal prenatal and postpartum treatment plan.

That can number changing treatments. For the case, she cited the contraindication of several medicines during pregnancy and the undetermined safety biographies of numerous medicinals used to treat HS, including systemic retinoids, finasteride, and spironolactone.

Kirby emphasised the significance of dermatology and obstetrical interpreters working together on a case's treatment throughout the gestation while recommending the relinquishment of a multidisciplinary operation approach for pregnant cases with HS. Because remedial operation can bear a different dynamic in each trimester, she continued, working with a platoon can be especially profitable for cases with HS.

Because numerous drugs can pass the placenta into the developing foetus, she noted," occasionally we will change the remedy with some medicinals like the biologics throughout the third trimester." This emphasises the significance of working with the case to understand the counteraccusations of maintaining the drug during the third trimester and communicating with the obstetrician," the author says.

Since HS and acne partake in an analogous etiological foundation, pregnancy in acne cases presents a similar set of challenges, according to Kirby. Thankfully, she noted, there are colourful classes of topical, oral, and topical antiseptic specifics that can be used safely. She believes that this list includes biologics, particularly tumour necrosis factor impediments, and metformin for milder forms of HS, for more severe conditions.

Hidradenitis suppurativa can worsen during pregnancy, so it's critical to continue treating the condition medically and, when needed, surgically under the supervision of both a dermatologist and an obstetrician." Enhanced care for these individualities can prop in better complaint operation and vastly enhance patient quality of life."

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