Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease with significant debility and psychological impact, especially during the late stages of the disease. Patients with advanced disease merit aggressive treatment, even during pregnancy. Studies show that pregnant women can have worsening symptoms (approximately 10%) or no relief (approximately 70%). Many HS therapeutic options are available during or before pregnancy, but practitioners may not be aware of these options.
Methods: We present three women with advanced stage HS to demonstrate therapies during pregnancy and outline the risk category, adverse effects, and potential fetal outcomes of each case.
Results: Case 1 is a 32-year-old woman with Hurley-Stage III HS of the bilateral groin, buttocks, and axillae. She underwent multiple treatments including benzoyl peroxide (BPO) wash, chlorhexidine, clindamycin lotion, intralesional steroid treatments, extended courses of combination benzoyl peroxide (PO) antibiotic treatments, spironolactone, PO prednisone, isotretinoin, dapsone, intravenous ertapenem, adalimumab, Nd-Yag laser, and CO2 laser excision of the sinus tracts in both axillae. Despite this, her disease progressed, and she required infliximab for stabilization. During her pregnancy, the HS flared, and she was managed with infliximab through dermatology, rheumatology, and maternal fetal medicine. Case 2 is a 29-year-old woman with Hurley-Stage III HS of the bilateral groin and axillae. She completed BPO wash, clindamycin lotion, extended combination courses of PO antibiotic treatments, intralesional steroid agents, and CO2 excision of the sinus tracts in the bilateral groin. The HS flared during pregnancy and was managed with BPO wash, PO clindamycin, and PO prednisone. Case 3 is a 39-year-old woman with Hurley-Stage III HS of the bilateral groin, inframammary region, and axillae managed with adalimumab while planning pregnancy.
Conclusions: As the recognition of HS improves, so should the management of pregnant patients. We can use data generated by patients with rheumatologic diseases to extrapolate safety for certain biologic agents during pregnancy.