How to Get Pregnant and Have a Healthy Pregnancy with Hidradenitis Suppurativa

Getting Pregnant with Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful, boil-like lumps to form in areas like the armpits, groin, and under the breasts. HS is not curable, but it can be managed with treatments like antibiotics, anti-inflammatory medications, and surgery. The constant flares and discomfort of HS may make you wonder if you can safely get pregnant and have a healthy baby.

The good news is that yes, you absolutely can get pregnant and carry a child to term even with hidradenitis suppurativa. However, there are some important considerations to be aware of when planning pregnancy with HS. Proper preparation and working closely with your doctors can result in a successful pregnancy and birth.

Effects of HS on Fertility and Pregnancy

HS itself does not directly impact fertility or make it harder to conceive. However, the location of HS lesions in the groin area can make intercourse uncomfortable during flares. HS also does not generally complicate pregnancy or cause pregnancy-related issues.

The main pregnancy risks are from HS treatments, rather than the condition itself. Certain medications used to manage HS symptoms are not considered safe during pregnancy and breastfeeding. That’s why reviewing your treatments with your doctors before trying to conceive is vital.

Working with Your Doctors

As you plan pregnancy, you’ll need to work closely with both your gynecologist/obstetrician and your dermatologist or HS specialist. Key things to discuss include:

• Evaluate your HS medications – some may need to be stopped or switched before conceiving.
• Discuss pain management options that are safe in pregnancy.
• Develop an HS flare treatment plan for during and after pregnancy.
• Consider adjusting delivery method if you have perineal HS.
• Talk about breastfeeding logistics with HS lesions.

Keep all your doctors updated on any changes in your HS symptoms or treatment during and after pregnancy. Ongoing communication ensures the best care for both you and your baby.

Stopping HS Medications Before Pregnancy

Many of the medications used to treat HS are considered unsafe during pregnancy due to risks they may pose to the developing fetus. Medications typically stopped prior to conception include:

• Methotrexate - Can cause birth defects.
• Acitretin - A retinoid that may harm fetus.
• Cyclosporine - Immunosuppressant that may increase complications.
• Mycophenolate - Immunosuppressant that increases birth defect risk.
• Tetracyclines - Antibiotics that impact bone/teeth development.

Work with your dermatologist to stop any unsafe HS treatments with enough time for medications to fully clear your system before trying to conceive. This ensures they will not impact a growing fetus.

Pregnancy-Safe HS Treatments

Some HS therapies may be continued during pregnancy to help manage symptoms. Options considered safe in pregnancy include:

• Topical clindamycin
• Oral erythromycin or penicillin antibiotics
• Warm compresses
• Loose, breathable clothing
• Laser hair removal to prevent ingrown hairs
• Incision and drainage of cysts when needed

Low strength topical steroids, antihistamines, pain relievers like acetaminophen, and certain biologics may also be deemed safe on a case-by-case basis by your doctor.

Flares During Pregnancy

You may experience fewer or less severe HS flares during pregnancy thanks to shifting hormone levels. However, some women see no change or even worsening of their HS symptoms. There is no way to predict how pregnancy will impact your flares.

If you do experience HS flares while pregnant:

• Use a warm compress on lesions to ease discomfort.
• Wear loose cotton clothing to avoid irritation.
• Practice good hygiene to prevent infection in lesions.
• Take sitz baths to soothe irritated skin.
• Use only pregnancy-safe medications.
• See your doctor promptly if a cyst becomes severely inflamed.

Make sure your obstetrician is aware of any HS flares so they can monitor you and baby closely.

HS Flare Treatments After Pregnancy

After giving birth, you can restart medications that were stopped during pregnancy under your doctor’s guidance. Post-pregnancy flare treatment options include:

• Resuming biologics, immunosuppressants, retinoids if needed.
• Restarting oral antibiotics if not breastfeeding.
• Continuing warm compresses and gentle hygiene.
• Wearing loose clothes that don't rub on lesions.
• Using laser hair removal to prevent HS triggers.
• Asking about studies for new, experimental HS therapies.

As you are able, move back to your normal HS treatment regimen to prevent debilitating flares.

HS Delivery Considerations

Vaginal delivery is possible for most women with HS. But if you have significant HS lesions in the genital or perineal region, a cesarean delivery may be recommended to avoid trauma to active flare sites. Discuss potential delivery methods with your obstetrician.

Other tips for delivery with HS:

• Use good hygiene prior to any skin-to-skin contact.
• Keep lesions clean and covered to minimize infection risk.
• Use numbing sprays/creams on flares during vaginal delivery.
• Take sitz baths and wear loose clothes post-delivery.
• Keep delivery staff updated on your HS lesions.

Listen to your body and obstetrician regarding the safest delivery approach based on your HS presentation.

Breastfeeding with Hidradenitis Suppurativa

Breastfeeding is possible for mothers with hidradenitis suppurativa. Be aware of a few key breastfeeding tips if you have HS:

• Practice careful hygiene around lesions before nursing.
• Use nursing pads to prevent friction on breast lumps.
• Try different nursing holds to avoid pressure on flare sites.
• Nurse on the non-affected breast if severe lesions are present.
• Watch for breast infection signs like fever or redness.

Check with your doctor about restarting oral HS medications while nursing. Topical treatments, antibiotics, and some biologics may be safe options when breastfeeding.

Caring for Yourself and Your Baby With HS

Hidradenitis suppurativa does not have to stop you from getting pregnant and having a healthy child. Work closely with your healthcare providers, avoid medications that could cause birth defects, and manage flares using safe options during pregnancy and nursing. While it presents some challenges, being proactive and smart about your care makes pregnancy and motherhood possible.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.