What to Know About Hidradenitis Suppurativa in Pregnancy

Hidradenitis suppurativa (HS) is a skin condition that causes painful sores and lumps deep in your skin where hair follicles get blocked and rupture. It can be painful and may limit mobility.

HS is a chronic inflammatory disease. This condition is also called acne inversa.

During pregnancy, 24% of people see improvement in HS symptoms, while 20% experience worsening of the condition and 60% report experiencing flares after delivery, according to a 2021 research review. Yet for most people with HS, the symptoms remain stable during pregnancy.

Symptoms of HS in pregnancy are the same as when you are not pregnant. They may include:

• large, painful red lumps in places where skin touches skin
• lumps in places where there are a lot of sweat glands and hair follicles
• blackhead-like spots
• abscesses
• scarring
• pus-filled tunnels under your skin

You are most likely to have HS symptoms in the following locations:

• armpits
• groin
• breasts
• inner thighs
• lower abdomen
• anus
• buttocks

The cause of HS is unknown. Experts believe that it involves a combination of hormonal, genetic, and environmental factors.

Pregnancy can trigger HS due to hormonal changes and weight gain. During pregnancy, certain people are at higher risk of developing HS. Risk factors include:

• smoking
• living with diabetes
• experiencing polycystic ovarian syndrome
• having black skin

People with HS during pregnancy are more likely to have the following complications:

• miscarriage
• gestational diabetes
• preeclampsia
• cesarean delivery
• birth defects
• anemia

HS has no cure. The first treatment during pregnancy is topical antibiotics applied directly to the sore areas. Your doctor may order oral antibiotics for more severe cases.

Other treatment options for HS during pregnancy may also include over-the-counter (OTC) pain medication and surgery.

Here are treatment options for HS:

Oral medications

Oral medications that a doctor may recommend or prescribe to treat HS during pregnancy include:

• Oral zinc supplements: Zinc may be beneficial in treating HS during pregnancy.
• Metformin: Metformin is an oral medication used to treat diabetes that may also be helpful for HS.
• Biologics: Biologics are antibodies injected into the skin to treat severe HS during pregnancy. Biologics are often stopped during the end of pregnancy.
• Acetaminophen (Tylenol): Acetaminophen is the medication most recommended during pregnancy to manage pain. Always consult with your healthcare professional before taking any OTC medications during pregnancy.

Surgery

Sometimes surgery is necessary to remove the areas of skin affected by HS. Surgical options for treating HS during pregnancy include:

• Incision and drainage of acute abscesses: A surgeon makes a small cut in the abscess and drains the pus.
• Local excision of persistent nodules, abscesses, and sinuses: A surgeon cuts and removes individual nodules, abscesses, or sinuses.
• Deroofing and curettage of persistent abscesses and sinuses: This involves a surgeon cutting and scraping away the upper layers of a lesion (like a sore abscess) and allowing the lower layers to remain and heal.
• Radical excisional surgery of an entire affected area: A surgeon removes an entire lesion (abscess or nodule) along with a small amount of tissue surrounding it.

Other options

Your doctor may use liquid nitrogen to freeze the area, according to the HS Foundation.

A healthcare team is essential to managing your HS during pregnancy. Your OB-GYN doctor will often coordinate with a dermatologist to help you develop a plan for medications and treatment that best fits your needs.

If you are taking medication for HS and plan to become pregnant or are currently pregnant, tell your healthcare team immediately. Some HS medications are not safe to take during pregnancy. It is essential to discuss with your doctor the risks and benefits of each drug.

Medications are only one part of a complete plan to manage the symptoms of HS. Here are other things you can do at home:

• Stop smoking: Smoking can worsen HS and is harmful to your unborn baby. If you smoke, stopping smoking may significantly improve your HS symptoms, as well as your health and that of your baby.
• Maintain a healthy weight for you: Being overweight increases friction in the areas where HS is common. A nutritious diet and weight management during pregnancy may reduce your HS symptoms.
• Bleach baths: Taking a bath with a tiny amount of chlorine bleach can reduce the odor from your wounds. Warm baths and compresses can be soothing as well.

Anxiety and depression are common for people with HS. A small 2023 study in Poland indicates that anxiety happens in 40% of HS cases and depression in 41% of cases.

Pregnancy increases your risk of both conditions. It is vital to know the risk of anxiety and depression and get help as needed.

Pregnancy can cause a worsening of your HS symptoms. It is impossible to predict how your HS will change during this time. You may need to make adjustments to your treatment plan with your healthcare team. After your baby is born, there is a 60% risk that you will experience a flare.

Usually, a dermatologist trained to recognize HS will diagnose this condition. The doctor will examine your skin for sores in the most common locations.

Occasionally, the doctor may perform a skin culture. This means they will take a sample of the fluid from the lumps and have this fluid tested to rule out other possible causes.

You cannot prevent HS during pregnancy. But avoiding triggers can decrease breakouts. Triggers include:

• a diet high in dairy and sugar
• obesity
• hot and humid weather
• deodorants and antiperspirants
• smoking
• tight clothing
• stress
• shaving

Can my partner catch hidradenitis suppurativa from me?

No, this skin condition does not spread to other people.

Does poor hygiene cause hidradenitis suppurativa?

No, HS is not a result of improper hygiene, sex, or anything else you have done. The cause is unknown and probably a combination of several factors.

How common is hidradenitis suppurativa?

Between 0.04% and 1.7% of the global population has HS. Because it is relatively uncommon, you may feel alone if you live with this condition. If you have HS, it may be helpful to seek out a support group for people with the condition.

Hidradenitis suppurativa can create challenges during pregnancy. Hormone changes and weight gain associated with pregnancy can cause HS symptoms to increase.

But different treatment options are available to help you manage your symptoms. Lifestyle changes are essential for minimizing the effect of HS. Working closely with your healthcare team to develop a personalized treatment plan is crucial and can help improve your quality of life.