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Trying To Conceive and HS: What To Know About Treatments

Medically reviewed by Steven Devos, M.D., Ph.D.
Posted on August 30, 2023

Planning to have a baby is an exciting time, but it can also be a bit nerve-wracking, especially if you have a chronic inflammatory disease like hidradenitis suppurativa (HS). Because there are various treatment options for HS, it’s important to plan ahead, with the help of your care team, when trying to conceive (become pregnant).

To better understand how to treat HS safely when trying to conceive, myHSteam spoke with Dr. Kelsey Flood, a board-certified dermatologist at Northwestern Memorial Hospital in Chicago and assistant professor of dermatology at Northwestern University Feinberg School of Medicine. Dr. Flood treats people with a variety of chronic (ongoing) skin conditions, including HS. She frequently discusses plans for childbearing with her patients.

Planning for Pregnancy With Your Dermatologist

If you have HS, planning is key when trying to conceive. It is important to talk with your care team about potential treatments, possible pregnancy complications and health problems, and even lifestyle changes to help ensure you have the best outcome possible.

Some HS treatments are safe to continue during pregnancy, while others are not. “I ask my patients to let me know if they’re planning to conceive in the next couple of years so we can take that into consideration for their treatment plan. If possible, that conversation should start well before you’re even thinking about having a baby,” said Dr. Flood.

Your OB-GYN is another key person on your care team and should be involved in these conversations because HS can get worse or lead to complications during pregnancy. Dr. Flood suggested putting your dermatologist and OB-GYN in touch with one another to communicate about your pregnancy plan. “Ideally, your dermatologist and OB should be talking about what’s going on so everyone’s on the same team. It’s important to have these conversations early on so we can try to control your disease and optimize things in a pregnancy-safe way prior to conceiving,” she said.

If you take medications for any other health conditions, you should consult the prescribing doctor to ask about safety when trying to conceive. Talk to your OB-GYN about any medications or supplements you take. Dr. Flood recommended that partners also check in with their health care providers to confirm that any medical treatments they are receiving are OK to take when starting a family.

HS Treatments To Avoid When Trying To Conceive

“There are certain treatments that are contraindicated in pregnancy and lead to birth defects, like methotrexate, retinoids (like isotretinoin), and certain antibiotics including tetracycline, minocycline, and doxycycline, among others,” Dr. Flood explained.

The hormonal treatment spironolactone is not considered safe for those with HS who are trying to become pregnant. Similarly, birth control pills prescribed to lessen the symptoms of HS cannot be taken while trying to conceive.

“Check in with your dermatologist on what medicines should be safe to continue and which ones you should stop, as well as the time frame in which you need to stop them,” Dr. Flood advised. Some medications have a longer wash-out period — the amount of time you must stop taking one medication before safely conceiving a child. “Some wash-out periods can last days, weeks, or months, as for isotretinoin. Others might take longer,” she said.

Safer Treatments for HS When Trying To Conceive

It’s important to understand that “just because something is considered safe doesn’t mean the risk is zero,” Dr. Flood noted when explaining which treatments are appropriate for trying to conceive and during pregnancy.

Because it would be unethical to conduct clinical trials on pregnant individuals, “we have to rely on retrospective data [details from the past] and clinical experience” about the safety of medications in pregnancy, Dr. Flood explained. As a result, “it’s always a risk-benefit discussion” between you and your health care providers, she said. Those conversations can include your dermatologist, obstetrician, and even your future baby’s pediatrician about increased risks and benefits to determine the best course of treatment before and during pregnancy.

Taking medication during pregnancy is common, and in many cases, stopping a medication can be harmful to the pregnant person’s physical and mental health.

Dr. Flood listed some treatment options that she prescribes for people looking to conceive:

  • Topical antibiotics — Placed on the skin
  • Oral antibiotics — Taken by mouth
  • Biologics — Medicine made from living cells
  • Systemic drugs — Medications that affect the entire body, not just a specific area

Antibiotics

“Topical clindamycin, metronidazole, and chlorhexidine are examples of safe topical antibiotics and washes to use in pregnancy,” said Dr. Flood. Studies have shown that using them on the skin or as washes isn’t likely to harm the baby, unlike if they are swallowed or injected into the body.

Dr. Flood also prescribes certain oral antibiotics, such as oral clindamycin. Dr. Flood noted that other oral antibiotics like rifampin and dapsone were listed as pregnancy category C in the prior classification and may pose a higher risk when trying to conceive based on the limited safety data available. “You would need to have a discussion with your physician if you take one of those,” she said. If the benefits are determined to outweigh the risks, you might choose to continue these medications.

Biologics

Biologic drugs like adalimumab (Humira) are sometimes used to treat HS. Using a biologic drug while trying to conceive and during pregnancy may be an option for you. If you are currently taking a biologic drug or are interested in taking one, your doctor will talk to you about the risk factors and benefits of taking biologics before or during pregnancy. In some cases, people take a biologic during their first two trimesters and stop it during the third.

Other Drugs

“Metformin is a medicine that we sometimes use in hidradenitis suppurativa and has been safely studied in pregnancy for patients with polycystic ovary syndrome, or PCOS,” Dr. Flood said.

Additionally, metformin helps lower blood sugar levels.

Systemic steroids are “probably OK if you need them for an acute flare, but there are a few things you need to know. There’s an increase in the risk of babies being born with low birth weight, as well as a higher chance of the baby being born earlier,” Dr. Flood added.

How Does HS Affect Fertility?

Studies have shown that people living with HS have more difficulty becoming pregnant and are at greater risk of experiencing a miscarriage. One study on male and female infertility among participants living with HS noted a higher risk of infertility among females between 36 and 45.

“If being a parent is important to you and you have concerns about fertility issues, I would suggest getting established with a reproductive endocrine infertility specialist to optimize your ability to conceive,” said Dr. Flood.

What To Do if You Have an Unexpected Pregnancy

Although planning ahead is ideal, not all pregnancies are expected. If you become pregnant unexpectedly, get in touch with your dermatologist, your OB-GYN, and any other doctors treating you for another medical condition as soon as possible. “Your doctors might want to stop some medications right away and may recommend additional lab tests or interventions,” Dr. Flood explained. Your health care team can provide advice on adjusting medications if needed and can make sure that you and your baby receive the best care.

Talk With Others Who Understand

On myHSteam, the social network and online community 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 living with HS and thinking about becoming pregnant? Do you have questions about your reproductive health or having a healthy pregnancy? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on August 30, 2023
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    Steven Devos, M.D., Ph.D. received his medical degree and completed residency training in dermatology at the University of Ghent, Belgium. Learn more about him here.
    Madalena Sánchez Zampaulo is a freelance writer and translator based in St. Louis, MO. She covers topics related to women's health, chronic conditions, and nutrition. Learn more about her here.

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