Why the skin condition hidradenitis suppurativa complicates pregnancy
February 7, 2023
Some skin conditions are common in pregnancy. From acnes and stretch marks to skin pigment changes, most of these flesh fluctuations are more annoying than dangerous.
Hidradenitis suppurativa (HS) – a chronic inflammatory skin condition – causes painful lumps, abscesses, and boils that can break the skin and become infected, causing serious illness that requires antibiotics and potentially surgery.
Recent research on HS and pregnancy suggests that having HS might significantly increase the risk of pregnancy complications including:
- Spontaneous pregnancy loss (37% increased risk)
- Preterm birth (25%)
- Gestational diabetes (59%)
- Gestational high blood pressure (38%)
- Preeclampsia, or severe high blood pressure in pregnancy (57%)
- Cesarean delivery (19%)
Researchers think the increased risk may be associated with chronic inflammation, infections, diet. Lesions can appear as lumps, blackheads, cysts, or narrow channels called sinus tracts under the skin. Also known as acne inversa, HS develops near hair follicles where there are sweat glands, often around the armpits, buttocks, breasts, and groin – sensitive areas that may already be uncomfortable for pregnant and breastfeeding patients.
I know having HS in pregnancy sounds scary. But when patients can get a timely and proper diagnosis, a dermatologist and Ob/Gyn can work together to help you manage HS before, during, and after pregnancy.
What causes hidradenitis suppurativa?
While an exact cause for hidradenitis suppurativa has not yet been found, it is not the result of poor hygiene, sexual activity, or any action taken by a patient – it can happen to anyone.
HS can be very painful, causing scarring over time. It’s not unusual for HS to be mistaken for other skin conditions, such as acne, boils, or herpes. However, it is not contagious.
About 10% of people have HS, and women in their 30s are disproportionately affected. According to the American Academy of Dermatology Association, Black women develop HS at a higher rate than other ethnicities. Additional risk factors may include a family history, excessive hair growth (hirsutism), smoking, and obesity.
Hormones have long been suspected to play a role in HS, but we are still learning how or why. Studies have shown that 43% of women with HS experience fewer symptoms during their periods, and 30% experience fewer symptoms during pregnancy. But more than half of women with HS reported no change in symptoms during those times.
Currently, there is no cure for HS. However, there are several safe, effective treatments to help pregnant patients manage and reduce flare-ups, heal wounds, and relieve pain. Talk with a dermatologist about your treatment plan before pregnancy or as soon as you find out you are pregnant – we can work with your Ob/Gyn to adjust your treatment plan as needed.
Which HS treatments are safe in pregnancy?
Medication
Medication can help manage pain, treat infection, reduce inflammation, or suppress the immune system response to the disease, which can decrease inflammation. For most patients with HS, it is safe to keep taking medications during pregnancy. However, we do not recommend retinoids or tetracycline during pregnancy – these drugs can treat acne and HS but may cause miscarriage, premature delivery, or birth defects.
Using an antimicrobial wash such as chlorhexidine or benzoyl peroxide two to three times a week or a topical antibiotic (applied to the skin) is typically the first choice to prevent HS flares and treat infections when you’re pregnant or breastfeeding. If a lesion is noticed early, a local steroid injection might reduce inflammation and pain.
Medications to suppress the immune system, such as adalimumab (Humira), infliximab (Remicade), or ustekinumab (Stelara), are generally considered safe during pregnancy. These medications deploy antibodies to block specific proteins in the body that cause inflammation. Your doctor may recommend stopping the medication during the third trimester to avoid transferring antibodies to the baby.
Acetaminophen, such as Tylenol, is a safe option for pain management. Aspirin and ibuprofen can cause problems for your baby and should be avoided during pregnancy. However, ibuprofen is safe to take while breastfeeding.
Related reading: Know the risks of taking ibuprofen, NSAIDs during pregnancy
Laser hair removal
For people with mild HS, laser hair removal can destroy the hair follicles – structures below your skin that grow individual strands of hair – that become blocked and cause lesions. The treatment can also remove sweat glands and reduce bacterial growth in the affected area, potentially reducing inflammation and pain.
While laser hair removal can reduce symptoms, it may not prevent flare-ups. Patients with moderate to severe HS may not experience benefits due to scarring and sinus tracts beneath the skin.
Research into the safety of laser hair removal during pregnancy is limited; talk with a dermatologist and your Ob/Gyn about whether it could be a good option for you.
Skin surgery
Surgery to remove affected skin may be necessary for severe cases of HS. A dermatologist may recommend one of these procedures before or after pregnancy:
- Removal of a single lesion
- Incision and drainage of affected lesions
- Wide excision, which includes removing a large area of skin and covering it with a skin graft
In severe cases, surgery may be recommended during pregnancy. But it’s generally safer to have skin procedures before or after pregnancy to avoid the risk of complications such as infection.
Diet and lifestyle changes
While several studies have examined the effect of different diets on hidradenitis suppurativa, none have been conclusive. However, there is a correlation between gut health and skin health.
Some research suggests that eating kefir – fermented yogurt – is better for gut health than taking an oral probiotic. I recommend my patients add two ounces of fermented yogurt twice a day to their diet, including during pregnancy.
Other things you can do to prevent HS flare-ups include:
- Do not smoke
- Limit sweating
- Avoid scented deodorants or skin products
- Wear loose-fitting clothing
Achieving and maintaining a healthy weight also can help manage HS. While weight loss typically isn’t advised during pregnancy, talk with your Ob/Gyn to determine a healthy amount of weight to gain based on your pre-pregnancy weight and overall health.
Having HS can take a toll on your mental health, too. If you experience symptoms of depression or anxiety, talk with your health care provider. We will connect you with a specialist who can help manage your symptoms.
Related reading: Getting pregnant and postpartum women mental health care faster
What to do if you have HS and are pregnant
As you and your doctor discuss existing health conditions such as diabetes and high blood pressure, make a point to talk with them about your history of HS – even if you have a mild case.
Let your doctors know right away if you notice a new lump or if you have pain during pregnancy or while breastfeeding. The more we can manage the lesion before it becomes a full flare-up, the better.
Hidradenitis suppurativa can be a frustrating condition, and it can increase the risk of pregnancy complications. But by working with a multidisciplinary team of health care providers, including your Ob/Gyn and dermatologist, we can find the best treatment plan for you and your baby.
To talk with a doctor about managing HS during pregnancy, call 214-645-8300 or request an appointment online.
