HS and Pregnancy: A Complete Patient Guide
How hidradenitis suppurativa affects pregnancy, which treatments are safe, what to expect postpartum, and how to build a care team that supports both you and your baby.
Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Medication decisions during pregnancy must be made in consultation with your dermatologist and obstetrician. Never start, stop, or change medications without professional guidance. Read full disclaimer.
Pregnancy is a time of profound physical and hormonal change, and for women living with hidradenitis suppurativa (HS), it raises important questions about disease activity, medication safety, and the health of both mother and child. Research on HS in pregnancy has grown significantly in recent years, providing clearer guidance for patients and clinicians. Understanding the hormonal factors that influence HS is also important context for pregnancy planning.
HS affects women at a 3:1 ratio compared to men, with peak onset during the reproductive years (ages 18-40). This means that pregnancy planning and management are central concerns for a large portion of the HS patient population. Understanding how HS behaves during pregnancy, which HS treatments are safe, and how to manage the postpartum period can help you navigate this time with greater confidence.
This guide draws on peer-reviewed research from the Journal of the American Academy of Dermatology, the British Journal of Dermatology, and European clinical guidelines to provide evidence-based information for patients and caregivers.
How HS Changes During Pregnancy
The relationship between HS and pregnancy is complex and highly individual. A 2020 systematic review published in Acta Dermato-Venereologica found that disease activity during pregnancy is unpredictable: some women experience significant improvement, others report worsening, and some see no change at all.[1]
Experience reduced flare frequency, particularly in the second and third trimesters, possibly due to elevated progesterone and immune modulation.
Report increased disease activity, especially in the first trimester and postpartum period when hormonal shifts are most dramatic.
Experience stable disease activity throughout pregnancy with no significant change from their baseline.
Why Hormones Play a Central Role
HS is strongly influenced by androgens (male hormones present in both sexes), which stimulate the hair follicle activity that drives HS lesion formation. During pregnancy, the hormonal environment shifts dramatically. Estrogen and progesterone rise significantly, while androgen activity is relatively suppressed in some women - which may explain improvement in some cases.
However, the postpartum period brings a rapid drop in estrogen and progesterone, which can trigger significant HS flares. Many women report their worst HS episodes in the weeks following delivery. This is an important period to plan for with your care team.
For a deeper understanding of how hormones affect HS, see our dedicated guide: HS and Hormones: Understanding the Connection.
Pregnancy Outcomes and HS
A 2021 population-based cohort study published in the British Journal of Dermatology examined pregnancy outcomes in women with HS compared to the general population.[5] The findings highlight the importance of proactive management:
Preterm Birth
Women with HS had a modestly elevated risk of preterm birth compared to controls. Severe, uncontrolled inflammation is thought to contribute to this risk through systemic inflammatory pathways.
Gestational Diabetes
HS is associated with insulin resistance and metabolic syndrome. Women with HS have a higher baseline risk of gestational diabetes, making glucose monitoring during pregnancy particularly important.
Cesarean Delivery
HS lesions in the groin, inner thighs, or perineal area may complicate vaginal delivery. Discuss delivery planning with your obstetric team early in pregnancy.
Postpartum Flares
The postpartum period carries a high risk of HS flares due to rapid hormonal changes. Planning for this period with your dermatologist before delivery is strongly recommended.
Important Context
These risks are modest in absolute terms and many women with HS have healthy pregnancies and healthy babies. The key is proactive management: working with a multidisciplinary team, maintaining disease control where possible, and planning for the postpartum period. HS does not prevent pregnancy or make pregnancy inherently dangerous.
Safe Treatments During Pregnancy
Treatment decisions during pregnancy require careful balancing of the risks of active HS disease against the potential risks of medications to the developing fetus. The following guidance is based on current clinical guidelines from the American Academy of Dermatology and the European Academy of Dermatology and Venereology.[2][7]
Generally Considered Safe
Use With Caution (Discuss With Your Physician)
Medications to Avoid During Pregnancy
Several medications commonly used for HS are contraindicated during pregnancy due to known teratogenic effects (ability to cause birth defects) or other fetal risks. If you are planning a pregnancy, discuss transitioning off these medications with your dermatologist well in advance.
| Medication | Risk | Washout Period |
|---|---|---|
| Tetracyclines (doxycycline, minocycline) | Tooth discoloration, bone growth impairment in fetus | Discontinue before conception |
| Retinoids (isotretinoin, acitretin) | Severe teratogen - causes major birth defects | 1 month (isotretinoin), 3 years (acitretin) |
| Methotrexate | Teratogen, abortifacient | 3-6 months before conception |
| Spironolactone | Anti-androgen effects may feminize male fetus | Discontinue before conception |
| Cyclosporine | Immunosuppression, potential fetal growth restriction | Discuss with physician |
This list is not exhaustive. Always review all medications with your dermatologist and obstetrician before and during pregnancy. For a full overview of HS treatment options, see our HS Treatments Guide.
Postpartum Management and Breastfeeding
Managing Postpartum Flares
The postpartum period is one of the highest-risk times for HS flares. The rapid drop in estrogen and progesterone after delivery, combined with physical stress, sleep deprivation, and the demands of newborn care, can trigger significant disease activity. Planning ahead is essential.
Before Delivery
- - Discuss postpartum flare management plan with your dermatologist
- - Have topical clindamycin and dressings stocked at home
- - Identify a support person who can help with wound care
- - Know when to contact your dermatologist urgently
After Delivery
- - Resume pre-pregnancy medications as soon as cleared by your physician
- - Monitor for new lesions in the first 4-6 weeks
- - Prioritize sleep and stress management where possible
- - Attend your 6-week dermatology follow-up
Breastfeeding and HS Medications
Breastfeeding decisions for women with HS require careful consideration of medication transfer into breast milk. Topical clindamycin is generally considered compatible with breastfeeding due to minimal systemic absorption. Adalimumab has limited data but is thought to have low transfer into breast milk and may be compatible with breastfeeding in some cases.
Tetracyclines, retinoids, and methotrexate are contraindicated during breastfeeding. The LactMed database (National Institutes of Health) is an excellent resource for checking the safety of specific medications during lactation.
NIH LactMed Database - Medication Safety During BreastfeedingBuilding Your Multidisciplinary Care Team
Managing HS during pregnancy requires coordination between multiple specialists. Ideally, your care team should be assembled before conception or as early as possible in the first trimester.
Dermatologist
Manages HS disease activity, adjusts medications for pregnancy safety, and provides wound care guidance. Should be informed of your pregnancy as early as possible.
Obstetrician / Maternal-Fetal Medicine
Manages overall pregnancy health, monitors for complications, and coordinates with your dermatologist on medication decisions. A maternal-fetal medicine specialist may be appropriate for complex cases.
Mental Health Professional
HS has significant psychological impact, and pregnancy adds additional emotional demands. A therapist or counselor familiar with chronic illness can be invaluable.
Registered Dietitian
Anti-inflammatory dietary strategies may help reduce HS disease activity. A dietitian can help you optimize nutrition for both HS management and pregnancy health.
Finding an HS Specialist
Not all dermatologists have experience managing HS during pregnancy. Use the AAD's Find a Dermatologist tool to locate a specialist, and ask specifically about their experience with HS in pregnancy.
Find an HS-Experienced DermatologistFrequently Asked Questions
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References
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