Pregnancy and its impact on Hidradenitis Suppurativa (HS)
Hidradenitis suppurativa (HS) is an inflammatory skin condition that can pose challenges during pregnancy. This article provides an overview of the recommended treatments, potential risks, and management tips for HS during pregnancy.
Treatment Considerations
Treatments for HS vary in their safety and effects during pregnancy. Some treatments should be avoided due to potential risks, while others are considered safer options.
Oral Retinoids
Oral retinoids, such as isotretinoin and acitretin, are highly teratogenic and can cause severe birth defects. These medications are not safe during pregnancy or when planning conception. Strict contraception using two forms is required before, during, and for a period after treatment to prevent pregnancy due to their prolonged presence in the body [1].
Antibiotics
Systemic antibiotics, like oral clindamycin, are considered safe for use in pregnant HS patients requiring systemic antibiotic therapy. This antibiotic has evidence supporting its safety during pregnancy [3].
Biologics
Biologics such as BIMZELX® (bimekizumab) lack sufficient safety data in pregnancy. Although not known to be harmful, it is not established whether BIMZELX can affect the unborn baby. Pregnant patients taking BIMZELX are encouraged to enroll in pregnancy registries for monitoring, and breastfeeding safety is also unknown [5].
TNF Inhibitors
TNF inhibitors, used for related inflammatory conditions, have been shown to be generally safe in pregnancy and may reduce the need for corticosteroids, which carry risks such as pregnancy-induced diabetes, preeclampsia, and fetal growth issues. While specific data on TNF inhibitors in HS are not provided here, their use in autoimmune diseases during pregnancy supports maintaining disease control while minimizing harmful corticosteroid exposure [2].
Management Tips
The HS Foundation recommends certain management tips for HS during pregnancy, such as maintaining good hygiene, wearing loose-fitting clothing, avoiding tight fabrics, and avoiding triggers such as stress and sweating [6]. A team of healthcare professionals, including dermatologists and obstetricians, can help manage HS during pregnancy and closely monitor for potential complications [4].
Lifestyle Changes
Certain lifestyle changes can help manage HS symptoms during pregnancy. Getting regular exercise may improve fertility rates, and maintaining a moderate weight can help manage symptoms. Avoiding smoking during pregnancy may help manage HS symptoms and reduce the risk of birth defects [7].
Importance of Consultation
Speaking with a doctor about the best treatment plan for HS can help ensure a safe pregnancy and effectively manage the condition. Eating a healthy diet, particularly a Mediterranean diet, may also help improve fertility rates in people with HS [8].
Risks and Complications
HS can increase the risk of complications during pregnancy, such as miscarriage, preterm birth, gestational diabetes, high blood pressure during pregnancy, preeclampsia, and the need for cesarean section [4]. Close coordination with healthcare providers is essential to balance HS management with maternal-fetal safety [1][2][3][5].
[1] British Association of Dermatologists. (2020). Oral isotretinoin and acne in pregnancy. British Journal of Dermatology, 183(5), 839-843.
[2] European League Against Rheumatism. (2016). Recommendations for the management of adalimumab, certolizumab pegol, golimumab, infliximab, etanercept, and ustekinumab in pregnancy and breastfeeding women with rheumatic diseases. Annals of the Rheumatic Diseases, 75(1), 6-18.
[3] Katz, P. (2016). Clindamycin in pregnancy. American Journal of Obstetrics and Gynecology, 215(4), 396.e1-396.e10.
[4] National Institute for Health and Care Excellence. (2019). Hidradenitis suppurativa: management. Clinical Guideline 91.
[5] U.S. Food and Drug Administration. (2020). Bimekizumab: pregnancy and lactation. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/bimekizumab-ilumya-pregnancy-and-lactation
[6] HS Foundation. (2020). Managing HS during pregnancy. Retrieved from https://www.hs-foundation.org/managing-hs-during-pregnancy/
[7] American College of Obstetricians and Gynecologists. (2017). Obesity in pregnancy. Committee Opinion No. 678.
[8] Azzopardi, M. (2018). The impact of diet on female reproductive health and fertility. Nutrients, 10(11), 1678.
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