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How Does HS Affect Pregnant And Breastfeeding Women?

If painful bumps, boils, or pimples keep returning to embarrassing places on your body, it’s time to see a dermatologist, a doctor specializing in skin. This is especially important if you are a woman of childbearing age. You may have hidradenitis suppurativa (HS).

What is HS?

HS is a chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. Over time, this causes:1

  • Abscesses
  • Pus
  • Inflammation
  • Tunnels under the skin
  • Scars

The most common locations of these symptoms include:2

  • Armpits
  • Groin
  • Buttocks
  • Under the breasts
  • Anal and genital areas

HS in women

Women have HS 3 times as often as men. The largest group of people with an HS diagnosis are 30 to 39 years old, which is a woman’s prime childbearing years.3,4

If you are a woman, your hormones seem to affect the course of your disease. Studies show that HS symptoms in women usually flare:5-7

  • Before your menstrual period
  • After you have a baby
  • As you approach menopause

After menopause, 48 percent of women report that their HS symptoms improve.8

If you are planning to get pregnant, are already pregnant, or are breastfeeding, there are some special considerations regarding your HS. You should discuss your medicines with your doctor. Some drugs are harmful to developing babies, and some pass through breast milk to babies.9

Fertility

Women with HS may find it hard to get pregnant. HS has been linked with irregular menstruation and infertility. Those symptoms sometimes occur along with:10,11

  • Acne
  • Hirsutism (abnormal growth of hair on a person’s face and body)
  • High levels of androgens (male hormones)

Studies have shown that the use of anti-androgen drugs (drugs that block male hormones) for treatment of HS can be effective. However, these drugs can harm unborn babies.10,11

Pregnancy

Research shows mixed results on the effect that pregnancy has on women with HS. Some researchers found that pregnancy does not change HS symptoms for most women. However, other researchers have found that HS symptoms get worse for some women during pregnancy.6,8

Research shows that taking oral zinc may stop HS flares. Zinc reduces inflammation and is safe for unborn babies.12

If you are pregnant and have HS, first-line (standard) treatments include:13

  • Local medicines applied to the surface or injected into lesions (sores)
  • Procedures including limited surgery or laser therapy
  • Lifestyle modifications, such as smoking cessation and stress reduction

Systemic medications that work throughout the body should only be considered if first-line treatments are not effective.13

Women with HS who are pregnant should avoid:13

  • Hormones
  • Retinoids (drugs with effects like Vitamin A)
  • Some drugs that decrease the body’s immune response

Your doctor should also monitor you for anemia (lack of red blood cells). Both HS and pregnancy have been linked to anemia. Anemia is a risk factor for preterm delivery and a low birth-weight baby.14

Your doctor should advise you on suitable weight gain during pregnancy. Being overweight is a risk factor for more severe HS symptoms.15

You may want to talk with your obstetrician-gynecologist to plan for delivery. If you have active lesions in the lower abdomen or genital region, a cesarean section that avoids the areas may be beneficial.16

Breastfeeding

If you have lesions on or near your breasts, you may be concerned about the effect on breastfeeding. You should seek medical treatment for lesions on your breasts before the baby is born. Lesions under the breasts do not usually affect a baby’s ability to breastfeed.16

Most importantly, doctors recommend that your dermatologist work closely with your obstetrician-gynecologist. Together, they can create a treatment plan that controls your HS and keeps you and your baby safe.16

Written by: Ina Fried | Last reviewed: December 2020
  1. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  2. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28:1013-1027. doi.org/10.1016/j.bpobgyn.2014.07.012.
  3. Jemec GB. Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366:158-164. doi:10.1056/NEJMcp1014163.
  4. Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017 Aug;153:760-764. doi:10.1001/jamadermatol.2017.0201.
  5. Vossen AR, van Straalen KR, Prens EP, van der Zee HH. Menses and pregnancy affect symptoms in hidradenitis suppurativa: a cross-sectional study. J Am Acad Dermatol 2017;76(1):155-156.
  6. Perng P, Zampella JG, Okoye G. Management of hidradenitis suppurativa in pregnancy. J Am Acad Dermatol . 2017 May;76(5):979-989. doi:10.1016/j.jaad.2016.10.032.
  7. Riis PT, Ring HC, Themstrup L, Jemec GB. The role of androgens and estrogens in hidradenitis suppurativa - a systematic review. Acta Dermatovenerol Croat. 2016 Dec;24(4):239-249. Available at https://pubmed.ncbi.nlm.nih.gov/28128074/. Accessed 7/9/2020.
  8. romann CB, Deckers IE, Esmann S, et al. Risk-factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014 Oct;171(4):819-824. doi:10.1111/bjd.13090.
  9. Patient perspectives: What is hidradenitis suppurativa (HS)? Society for Pediatric Dermatology. Available at https://pedsderm.net/site/assets/files/1028/spd_hidradenitis_color_web.pdf. Accessed 7/9/2020.
  10. Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and polycystic ovarian syndrome: systematic review and meta-analysis. Australasian Journal of Dermatology. 2020;61:e28-e33. doi:10.1111/ajd.13110.
  11. Randhawa HK, Hamilton J, Pope E. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. JAMA Dermatol. 2013;149(6):732-735. doi:10.1001/jamadermatol.2013.2874.
  12. Brocard A, Knol A, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. Dermatology 2007;214(4):325-327.
  13. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101.
  14. Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000;71(5):1280S-1284S.
  15. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol 2013;121(1):210.
  16. Collier E, Shi VY, Parvataneni RK, et al. Special considerations for women with hidradenitis suppurativa. Int J Womens Dermatol. 2020 Feb 19;6(2):85-88. doi:10.1016/j.ijwd.2020.02.005.