Study Highlights Findings on Treatments for HS During Pregnancy, Lactation

There are a set of unique challenges with hidradenitis suppurativa (HS) management during pregnancy and the lactation period, according to recent findings, with adalimumab, antiseptic washes, oral clindamycin-rifampicin, topical clindamycin, metformin, and certolizumab pegol being treatments with data that support their use.1

These findings and others were highlighted by investigators in a recent literature review, conducted to address gaps in knowledge with treating HS during and after pregnancy. The investigators of this analysis were led by Laşin Özbek of the School of Medicine at Koç University in Istanbul.

Özbek and colleagues noted that there had been limited safety data for pregnant and breastfeeding women. They added that this led to a narrow therapeutic window and often resulted in suboptimal outcomes of treatments.2

“This review seeks to summarize the current literature on the treatment of HS during pregnancy and lactation, offering clinicians guidance to support their decision-making,” Özbek and colleagues wrote.1

Background and Literature Review

The research team highlighted that the underlying mechanisms influencing shifts in the disease course of HS at the time of pregnancy and during the postpartum period remain relatively less understood. However, the team noted that estrogen-to-progesterone ratio shifts are believed to play a part in the process.

The investigators highlighted the link that had previously been identified between estrogen and increased proinflammatory Th1 differentiation. Additionally, they pointed to the promotion by progesterone of immune-modulatory Th2 and Treg cells, leading to a potential mitigation of inflammation.

Additionally, they noted the contributions of cytokine fluctuations, particularly those known to involve IL-1 and TNF-α, to the body’s inflammatory processes alongside the role of adipocytes. The latter are known to secrete TNF-α and thereby exacerbate resistance to insulin.

Another challenge faced during this period for pregnant women with HS is adherence to medication. The investigators highlighted prior research suggesting that among 127 females reporting HS across 202 pregnancies, only 38.1% adhered to their prescribed therapies (P < 0.05). Improved medication adherence has been linked, however, to the involvement of dermatologists.

The researchers also noted that a significant proportion of women who have HS are prescribed medications that have been classified as pregnancy category C or higher, pointing to the critical value of preconception counseling. They further highlighted data showing that in the postpartum period, active HS lesions in regions such as the axilla, breast, or inframammary folds can lead to hindrances of the ability or willingness to breastfeed.

For the purposes of assessing existing data, the investigators carried out their systematic literature search. Their sights were set specifically on trials that included original patient data on HS management in those who are pregnant and lactating.

Major Findings on HS-Related Treatment Data

The investigative team determined that, given the fact that HS predominantly impacts young adults and particularly females who are of reproductive age, HS flares are commonly seen during pregnancy and postpartum. Such a finding, they noted, underscores the necessity of developing tailored approaches by clinicians to management for this population.

The team further expressed that the compounding chronic and relapsing nature of HS along with concerns related to adherence, safety of treatments, comorbidities, and psychological issues, further complicates disease management.

They highlighted a set of treatments for HS, including topical clindamycin, adalimumab, metformin, oral clindamycin-rifampicin, antiseptic washes, and certolizumab pegol. The researchers noted that these therapies have demonstrated relative safety in those who are pregnant and lactating.

In particular, the research team pointed to certolizumab pegol as having shown demonstrated promising safety data among biologic therapies, though they also noted that additional efficacy research in patients with HS are needed.

The investigators added that secukinumab and bimekizumab are 2 treatments that show potential for those considered to be part of the general HS population. However, they noted that the drugs both lack sufficient safety data for implementation among those who are pregnant and breastfeeding.

Overall, the research team highlighted the urgent necessity for comprehensive new research, given the limited data available on HS in these populations.

“Managing HS in these situations requires careful management and thorough consideration, especially when considering the safety of medications,” they wrote. “The management of HS during pregnancy and lactation relies mainly on limited data from observational studies rather than high-quality trials, as evidenced by our literature review.”1

References

1. Özbek, L., Güldan, M., Alpsoy, E. and Vural, S. (2025), Hidradenitis Suppurativa Treatment During Pregnancy and Lactation: Navigating Challenges. Int J Dermatol. https://doi.org/10.1111/ijd.17672.
2. A. B. Lyons, A. Peacock, S. A. McKenzie, et al., “Evaluation of Hidradenitis Suppurativa Disease Course During Pregnancy and Postpartum,” JAMA Dermatology 156, no. 6 (2020): 681–685.