From planning your pregnancy to childbirth, you’ve had to consider how hidradenitis suppurativa (HS) will affect your journey to parenthood. Now that your baby is here, you may wonder how your HS symptoms will change with the fluctuations in your hormones or how lesions under your breast may affect breastfeeding.

To better understand postpartum and breastfeeding with HS, myHSteam spoke with Dr. Tarannum Jaleel, a board-certified dermatologist and an assistant professor of dermatology at Duke University School of Medicine.

HS Symptoms Postpartum

If you noticed a change in your HS symptoms while pregnant, you may wonder how you’ll feel postpartum. Unfortunately, it’s hard to predict. Experiences vary, and more research is needed about HS symptoms after giving birth, Dr. Jaleel noted.

“I just had a baby, and my HS is doing much better now that I’m not pregnant,” one myHSteam member shared.

More myHSteam members report worsening symptoms during the postpartum period:

• “I am five weeks postpartum, and it’s worse now than ever.”
• “My HS symptoms were terrible during pregnancy and even worse after!”
• “I noticed that hormones trigger mine, which are going crazy right now with a newborn.”
• “Since having my twins six months ago, my HS flares have been nonstop. But I’m not losing hope that I can get this under control.”

People may experience HS flares after giving birth for many reasons. “A lot of patients come off therapy during their third trimester because they don’t want the medication to transmit to the baby,” Dr. Jaleel explained. She said more research is needed to determine if and how that contributes to postpartum HS flares.

“Weight gain can also contribute some inflammatory cytokines to the flare,” Dr. Jaleel added. “And then there are hormone shifts with lactation. There’s just too much data floating out there to be able to make sense of it without doing a prospective study.”

If you notice new or worsening HS symptoms during the postpartum period, tell your health care provider so they can help you feel better. Sharing these changes with your doctor helps them customize the most suitable care for you. This guidance will lead you toward a smoother postpartum journey.

Breastfeeding With HS

HS lesions or abscesses on and around the breasts can interfere with breastfeeding. Dr. Jaleel offered strategies to help minimize discomfort and preserve the breastfeeding relationship if that is your goal.

“I see patients whose HS lesions affect the breasts, and sometimes we recommend pumping at that point,” Dr. Jaleel explained. “If trauma to the breast is causing pain when your baby latches on, don’t feel like you have to breastfeed every single time.”

If only one breast is affected, Dr. Jaleel suggests nursing on one side and pumping the affected breast. Or, take a break from breastfeeding altogether and pump both. To maintain your milk supply while you heal, try to hand express or pump on your baby’s regular feeding schedule.

“If there is an abscess on the breast, you can use warm compresses,” Dr. Jaleel said. Also, consider wearing loose-fitting clothing and wearing a soft nursing bra to give your skin a chance to heal.

Many mothers who breastfeed look for help from lactation consultants. Before working with a lactation consultant, ask if they have experience working with people with HS or other skin conditions that can affect nursing, like psoriasis or eczema. If you can’t find a lactation consultant locally, consider looking for one who offers virtual appointments. You can also get help from other medical professionals, including those specializing in women’s health, obstetrics, or pediatrics.

Treating HS When Breastfeeding

Some treatment options for HS are systemic, meaning they circulate throughout the bloodstream to target the entire body. If you are breastfeeding, there are special considerations when choosing drugs. The medications you used while pregnant are most likely appropriate to continue using as you nurse, and additional options might be available after pregnancy.

Discuss your plans for breastfeeding with your dermatologist to ensure you can find the right HS treatment for you and your new baby. You can also get in touch with your obstetrician and your baby’s pediatrician.

“There are some drugs you shouldn’t use because they get in the breast milk,” Dr. Jaleel explained. “There are others that transfer, but they’re transferring in such small quantities that we don’t worry too much about them.”

Antibiotics

Topical antibiotics are safe for people who are pregnant or breastfeeding. These HS treatments are available in lotions, creams, and gels and are applied to the skin.

You may need an oral antibiotic if you have moderate or severe HS. Not all oral antibiotics are appropriate for breastfeeding. Your doctor can help you understand the risks and benefits of your options.

Biologics

Biologics are drugs made from living cells and are generally considered safe for pregnant people and those who are breastfeeding. However, some doctors recommend stopping them during the third trimester. Not many biologics have been studied in people who are pregnant and breastfeeding. Your doctor can help you understand any risks associated with taking biologic drugs while breastfeeding. Biologics for HS include adalimumab (Humira) and infliximab (Remicade).

Corticosteroids

Corticosteroids (steroids) can help reduce swelling and inflammation caused by HS. Small amounts of some steroids, like prednisone, may transfer to breast milk, but not enough to cause concern. Corticosteroids are generally considered safe for breastfeeding.

Hormonal Birth Control

Oral contraceptives can be used to treat mild HS. They are safe to use while breastfeeding but may reduce breast milk production. Some health experts recommend waiting four to six weeks after giving birth to use oral contraceptives for HS symptoms.

Retinoids

More research is needed to determine if retinoids are safe to use while breastfeeding, but most doctors recommend not using them to treat HS for people who are breastfeeding, pregnant, or trying to conceive. Your dermatologist and obstetrician can provide guidance.

Taking Care of Yourself Postpartum

Having a baby is a life-changing event. Suddenly, there is a tiny human who depends on you for everything. If you find yourself putting your own needs aside during the postpartum period, remember that taking care of your physical and mental health is essential for your ability to care for your newborn.

“I’ve seen many patients miss appointments during this period,” Dr. Jaleel said. “There’s a lot of competing life going on at the same time. Try to prioritize yourself and your health because it’s very easy to put yourself on the back burner.”

“As moms, we prioritize our children in many ways. It’s impossible not to,” Dr. Jaleel empathized. “But try to have a plan, so you know who will help out when you need to make those appointments. I feel like that’s when I’ve seen the disease progress a lot — when you have periods of stress, and you’re not able to take care of a disease that’s active and flaring.”

The postpartum period is also a time of increased risk for mental health issues. Approximately 50 percent to 75 percent of people experience some sadness and anxiety after giving birth, and an estimated 1 in 7 develop postpartum depression. To ensure you get the care you need, consider joining a support group, enlisting the help of a therapist, talking to a trusted family member or friend, and having a conversation about mental health with your doctor.

“Hormones and stress can play a big part in HS flares,” said one myHSteam member. “Make sure you keep up with your mental health. Mommies need time, too!”

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 35,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Are you breastfeeding with hidradenitis suppurativa? Share your experience in the comments below, or start a conversation by posting on your Activities page.