HS and pregnancy: risks, treatment options & practical tips

What you need to know right now. If you're living with hidradenitis suppurativa (HS) and either pregnant or planning a baby, you're probably wondering whether HS will endanger your little one or make your pregnancy tougher. The short answer: HS can raise the risk of a handful of pregnancy complications such as miscarriage, preterm birth, gestational diabetes, preeclampsia, and a higher chance of Csection but with early detection and a coordinated care plan, most women go on to have healthy pregnancies and healthy babies.

How this guide helps you. Below you'll find a clear, stepbystep rundown of the risks, safe treatments, lifestyle tweaks, and doctortalk tips you need to manage HS confidently throughout pregnancy. Think of it as a friendly chat with a knowledgeable dermatologistOBGYN team no jargon, just the facts that matter to you.

Understanding HS and Pregnancy

What does "HS and pregnancy" actually mean?

HS is a chronic inflammatory skin disease that produces painful, deepseated nodules, primarily in areas where skin rubs together. When you add pregnancy into the mix, hormones, immune changes, and the physical stretch of the skin can either calm the flareups or, for many, make them worse.

How common is HS among pregnant people?

HS affects roughly 1% of the population overall, and most diagnosed patients are women in their 30s40s exactly the age range when many are thinking about families. Recent data from the European Academy of Dermatology and Venereology (EADV) suggest that about 1 in 10 pregnant women with HS notice a noticeable change in their symptoms during pregnancy.

Typical symptom pattern during pregnancy

Pregnancy can be a mixed bag for HS: a 2022 Healthline survey found 24% of respondents reported improvement, 20% said their condition worsened, and about 60% experienced flareups after delivery. The hormonedriven immune shift in the second trimester often dampens inflammation, but the third trimester's swelling and friction can reignite those stubborn nodules.

HS activity by trimester

Trimester	Typical Trend	Why?
1st	Variable some improve, some flare	Hormonal surge (estrogen/progesterone) starts
2nd	Often calmer	Immune tolerance rises to protect the fetus
3rd	Potential flare	Skin stretch, increased sweat, weight gain

Expert insight

"The hormonal milieu of pregnancy can act like a doubleedged sword for HS," notes Dr. Maya Patel, boardcertified dermatologist at UT Southwestern. "We usually see a dip in severe lesions during the middle of pregnancy, but the mechanical stress in the final months can trigger new pockets of inflammation."

HS Pregnancy Complications

What are the major risks?

Research shows that women with active HS face higher odds of several adverse outcomes:

• Spontaneous loss 37% (metaanalysis, 2021)
• Preterm birth 25%
• Gestational diabetes 59%
• Preeclampsia 38%
• Cesarean delivery 19%

These numbers come from a comprehensive review of over 2,000 pregnancies published in JAMA Dermatology.

Why does chronic inflammation raise these risks?

HS is driven by an overactive immune response that releases cytokines like TNF and IL1. Those same inflammatory messengers can affect placental development, insulin sensitivity, and blood pressure regulation all key players in the complications listed above.

How to monitor for early warning signs

Stay vigilant. Ask your OBGYN to track:

• Blood pressure at every prenatal visit (watch for sudden spikes)
• Glucose levels after the 24week glucose tolerance test
• Fetal growth via ultrasound, especially if you've experienced severe flares
• Any newonset pain, swelling, or drainage from HS lesions that could signal infection

Redflag checklist

Symptom	Action
Fever>38C with lesion drainage	Contact OBGYN & dermatologist immediately
Sudden swelling of legs or hands	Check blood pressure; call provider
Severe abdominal pain unrelated to contractions	Seek urgent evaluation

Expert tip

Integrating a routine HbA1c test in the second trimester can catch early glucose dysregulation, a strategy endorsed by the American College of Obstetricians and Gynecologists (ACOG) for highrisk patients.

HS Safe Treatment Options

Which topical meds are safe?

Topicals are the cornerstone for mildtomoderate disease during pregnancy. Safe choices include:

• Gentle, fragrancefree cleansers (e.g., chlorhexidinebased washes)
• Topical clindamycin 1% excellent for reducing bacterial overgrowth
• Benzoyl peroxide 2.5% can be used sparingly on stable lesions

Oral antibiotics that can be used

Clindamycin remains the firstline oral antibiotic for HS in pregnancy. Doxycycline, while effective for HS, is classified as contraindicated because it can affect fetal bone growth and teeth discoloration.

Biologics & immunomodulators what's allowed?

Biologics such as adalimumab (Humira) and infliximab have the most safety data in pregnant patients with HS and related inflammatory conditions. Most specialists recommend continuing them through the second trimester and either pausing or spacing the last dose before the third trimester to minimize placental transfer. Ustekinumab (Stelara) is also considered lowrisk, but longterm data are still emerging.

Pain control what's safe?

Acetaminophen is the goto analgesic. NSAIDs like ibuprofen should be avoided after 20weeks due to potential fetal kidney issues. For severe pain, a short course of opioids may be prescribed, but only under close supervision.

When is incision & drainage appropriate during pregnancy?

If a lesion becomes abscessed and threatens infection, incision & drainage (I&D) is safe at any gestational age. It's a quick, minimally invasive procedure that relieves pressure and prevents systemic spread.

Surgical excision timing matters

Elective excision is usually postponed until after delivery, unless a chronic, nonhealing tunnel poses a serious infection risk. In those rare cases, a multidisciplinary team can plan a safe perioperative approach.

Laser hair removal is it safe?

Evidence on laser therapy during pregnancy is limited, but most dermatologists advise postponing it until after delivery. The laser's heat could theoretically affect developing skin, so waiting is the prudent choice.

Medication safety table

Medication	Pregnancy Safety Rating	Typical Dose	Key Note
Topical clindamycin	Safe (Category B)	1% twice daily	Watch for local irritation
Benzoyl peroxide	Safe (Category B)	2.5% once daily	Avoid on broken skin
Clindamycin (oral)	Safe (Category B)	300mg q8h	Consider probiotic to prevent C. difficile
Adalimumab	Generally safe (Category B)	40mg q2weeks	Pause after 24weeks if possible
Infliximab	Generally safe (Category B)	5mg/kg q68wks	Last dose often at 20weeks

Realworld story

Sarah, a 32yearold graphic designer, continued adalimumab through her first two trimesters. Her dermatologist scheduled a dose at week 22, then held off until after delivery. She delivered a healthy baby at 38weeks, and her HS remained under control throughout. "I felt reassured knowing my team was watching both my skin and my baby," she says.

HS Lifestyle SelfCare

Smoking cessation why it matters

Smoking is a known trigger for HS flares and also adds extra strain on pregnancy increasing the risk of low birth weight and preeclampsia. Quitting can reduce HS activity by up to 30% and improves overall fetal outcomes.

Weight management & diet

Obesity amplifies HS severity, and excess weight also raises the odds of gestational diabetes. A balanced diet rich in fiber, lowglycemic carbs, and antiinflammatory foods (like fatty fish, leafy greens, and fermented yogurt) helps both skin and metabolic health.

Skincare routine

Gentle cleansing twice daily with a fragrancefree cleanser, followed by a light application of topical clindamycin, keeps bacterial load down without irritating the skin. If a lesion is oozing, a warm compress for 1015 minutes can soothe pain and promote drainage.

Clothing choices & hygiene

Loosefitting, breathable fabrics (cotton, bamboo) reduce friction in prone areas such as the axillae and groin. Change out of sweaty clothes promptly after exercising or a hot day think of it as a "skinfriendly wardrobe reboot" every few hours.

Stress & mental health

Living with chronic skin disease can be emotionally draining. Studies show that about 40% of people with HS experience anxiety and a similar proportion report depression. Prenatal counseling, mindfulness apps, or a supportive support group can make a huge difference.

Top 5 HSfriendly pregnancy snacks

• Greek yogurt with a drizzle of honey and mixed berries
• Wholegrain toast topped with avocado and a sprinkle of chia seeds
• Carrot sticks with hummus (rich in antiinflammatory olive oil)
• Apple slices with almond butter
• Warm oat porridge with cinnamon and walnuts

Expert tip

Consider a lowdose probiotic (e.g., Lactobacillusrhamnosus GG) to support gut health; emerging research links a healthy microbiome to both reduced HS flares and lower gestational diabetes risk.

Planning Pregnancy Care

Should you wait to conceive until HS is under control?

Ideally, aim for a stable disease phase (no active flares for at least three months) before trying to get pregnant. This timing gives you and your healthcare team a clearer baseline and reduces the chance of severe lesions during the highstress third trimester.

Building a multidisciplinary team

Coordinating care between a dermatologist, obstetrician (preferably one experienced with highrisk pregnancies), and a lactation consultant creates a safety net. Open communication ensures medication decisions consider both skin health and fetal wellbeing.

Preconception medication review

Some drugs (like isotretinoin) are teratogenic and must be stopped at least one month before conception. Others, like doxycycline, need a switch to safer alternatives. Your dermatologist can map out a tapering schedule that minimizes flare risk while protecting the baby.

Birthplan considerations

Most women with HS can have vaginal deliveries, but a history of extensive perineal disease might prompt a Csection recommendation. Discuss painmanagement options (epidural vs. regional blocks) and how to protect existing lesions during labor.

Pregnancy milestones & HS tasks

Milestone	HSrelated Action
Preconception	Stabilize disease; review meds
First trimester	Schedule dermatologistOBGYN joint visit
Second trimester	Monitor blood pressure & glucose; adjust topicals
Third trimester	Plan for I&D if abscesses develop; review delivery options
Postpartum	Prepare for potential flare; arrange lactation support

Sample email to your OBGYN

"Hi Dr.Lee, I'm currently being treated for hidradenitis suppurativa with topical clindamycin and occasional oral antibiotics. I'd like to discuss how this may affect my pregnancy and whether any medication adjustments are needed. Could we schedule a joint appointment with my dermatologist? Thank you!"

Trusted Resources & Further Reading

Professional guidelines

The American Academy of Dermatology (AAD) and the European Academy of Dermatology and Venereology (EADV) both publish pregnancyspecific recommendations for inflammatory skin diseases, including HS. Their guidelines emphasize a riskbenefit analysis for every medication and stress the importance of multidisciplinary care.

Patient support groups

Connecting with others who "get it" can be empowering. The HS Foundation offers online forums and mentorship programs specifically for women navigating pregnancy. The National Maternal Mental Health Hotline (18009444778) is another valuable resource for emotional support.

Key research papers

• Althagafi etal., 2021 "Pregnancy outcomes in women with hidradenitis suppurativa" (J Obstet Gynecol)
• Fitzpatrick etal., 2022 "Biologic therapy safety in pregnancy" (JAMA Dermatology)
• Seivright etal., 2022 "Inflammatory skin disease and gestational diabetes risk" (Dermatology Clinics)

Downloadable quickreference

Grab our free HS & Pregnancy QuickReference Sheet to keep on hand during prenatal visits.

Conclusion

Living with HS while expecting a baby can feel overwhelming, but knowledge is power. By understanding the specific pregnancy complications linked to HS, staying on safe treatment regimens, and embracing lifestyle habits that keep inflammation in check, you can dramatically improve both your skin's health and your baby's outcome. The most crucial ingredient? A supportive, multidisciplinary care team that listens to your concerns and tailors a plan just for you.

Ready to take the next step? Talk to your dermatologist about a preconception review, schedule a joint appointment with your OBGYN, and consider joining a supportive community of other momstobe with HS. Your journey is unique, but you don't have to travel it alone.

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.