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Special Populations Affected By Hidradenitis Suppurativa

Hidradenitis suppurativa, or HS, is a chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. The process leads to:1

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

The pain, odor, appearance, and random flares of symptoms often reduce the quality of life of anyone living with the condition. However, there are some special groups of people with HS who need special care.2

HS in teens

HS generally appears after puberty. Less than 2 percent of people are younger than 11 years old when HS develops.3

HS affects 15 out of every 100,000 people who are between 0 and 17 years old. That is much lower than the rate – 172 out of every 100,000 people – reported for the most common age group of 30 to 39 years old.4

If you are younger than 17 when HS begins, you probably are female and have a: 5,6

  • Family history of HS
  • Hormonal imbalance
  • Pilonidal sinus, a small hole or tunnel in the skin at the top of the buttocks, where they divide
  • Highly inflammatory form of acne
  • Longer duration of HS
  • Feeling that your HS is severe

The goals of treatment for people with HS are:5

  • To reduce pain
  • Decrease inflammation and scarring
  • Prevent spread of the disease
  • Postpone the need for surgery

If you are a teen, HS can seriously damage your quality of life. While you are maturing physically and sexually, you are sensitive to what other people think of you. HS makes the normal threats to your self-esteem and body image even worse. The pain, odor, pus, and appearance of HS increase your challenges at school and at work.7

People with HS often have feelings of anxiety, social isolation, and depression. Your doctor can help you find resources to deal with those feelings.8

HS in pregnant and breastfeeding women

Women have HS 3 times as often as men. Among people with HS, most are between the ages of 30 and 39. These are also a woman’s prime childbearing years.4

If you are a woman, your hormones seem to affect the course of your disease. Studies show that HS tends to flare:9-12

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

After menopause, nearly half of women (48 percent) report their HS improves.12

Research on the effects of HS on pregnancy are mixed. Some researchers have found that pregnancy does not change HS for most women. However, others found that HS symptoms get worse for women during pregnancy.10,12

If you are pregnant, planning to get pregnant, or breastfeeding, you should discuss what medicines you take with your doctor. Some drugs used to treat HS are harmful to developing babies, and some pass through breast milk to the baby.8

If you have lesions (sores) 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 your breasts do not usually affect your baby’s ability to breastfeed.13

Most importantly, doctors recommend that your dermatologist work closely with your obstetrician/gynecologist. Together, they can create a treatment plan that keeps you and your baby safe while controlling your HS.13

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. Mac Mahon J, Kirthi S, Byrne N, et al. An update on health-related quality of life and patient-reported outcomes in hidradenitis suppurativa. Patient Relat Outcome Meas. 2020;11:21-26. doi.org/10.2147/PROM.S174299.
  3. Palmer RA, Keefe M. Early-onset hidradenitis suppurativa. Clin Exp Dermatol. 2001;26(6):501-503. doi:10.1046/j.1365-2230.2001.00876.x.
  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. Liy-Wong C, Pope E, Lara-Corrales I. Hidradenitis suppurativa in the pediatric population. J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S36-41. doi:10.1016/j.jaad.2015.07.051.
  6. Molina-Leyva A, Cuenca-Barrales C. Adolescent-onset hidradenitis suppurativa: prevalence, risk factors and disease features. Dermatology 2019;235:45-50. doi.org/10.1159/000493465.
  7. Collier E, Shi VY, Hsiao JL. Management of adolescents with hidradenitis suppurativa. J Dermatolog Treat. 2020 Jan 23;1-4. doi:10.1080/09546634.2020.1716933.
  8. Patient perspectives: What is hidradenitis suppurativa (HS)? Society for Pediatric Dermatology. Available at https://pedsderm.net/for-patients-families/patient-handouts/. Accessed 7/9/2020.
  9. 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.
  10. 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.
  11. 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.
  12. Kromann 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.
  13. 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.