Evaluation of Hidradenitis Suppurativa Disease Course During Pregnancy and Postpartum

Abstract

Importance: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing potential. There is a paucity of data regarding the HS disease course during pregnancy and in the postpartum period.

Objective: To explore the HS disease course during pregnancy and in the postpartum period.

Design, setting, and participants: A retrospective cohort study was conducted on patients in the Henry Ford Health System, Detroit, Michigan-a large, academic, urban referral center. Women with a diagnosis of HS who became pregnant between January 1, 2008, and December 31, 2018, were included. International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, were used for identification of the diagnosis.

Exposures: Pregnancy in patients with HS.

Main outcomes and measures: Hidradenitis suppurativa disease status during pregnancy and the postpartum period.

Results: A total of 127 women with HS were included in this study and accounted for 202 pregnancies. Of the 202 pregnancies, 171 were in black women, 25 in white women, 3 in women of other race/ethnicity, and 3 had unreported data. Mean (SD) age at HS onset was 19.3 (5.6) years; at time of HS diagnosis, 24.4 (5.3) years; and at time of pregnancy, 25.9 (5.0) years. The disease worsened during pregnancy in 70 pregnancies (61.9%), did not change in 34 pregnancies (30.1%), and improved in 9 pregnancies (8.0%). Hidradenitis suppurativa exacerbated in the postpartum period after 82 of 124 pregnancies (66.1%). Dermatologists were involved in managing HS in 28 pregnancies (14.4%) and for a higher proportion of patients with more severe Hurley stage as compared with cases of mild disease (stage 3: 7 of 18 [38.9%] vs stage 1: 10 of 100 [10.0%] or stage 2: 11 of 67 [16.4%]; P = .004). In addition, HS medical treatment was administered during 77 pregnancies (38.1%), while HS procedural treatment was administered during 34 pregnancies (16.8%). A significantly higher proportion of patients whose care was managed by dermatologists vs those without dermatologist involvement received any HS medication (22 [78.6%] vs 53 [31.7%], P < .001) or any HS procedure (14 [50%] vs 19 [11.4%], P < .001) during pregnancy.

Conclusions and relevance: Despite a high rate of HS exacerbation during pregnancy and postpartum, this cohort study found that most of the patients did not receive HS-directed medical treatment or care from a dermatologist during pregnancy. Close monitoring and improved collaborative care between dermatology and obstetrics-gynecology services is warranted.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Lyons reported receiving equipment from Lenicura (unpaid) and General Electric and grants from Lenicura, General Electric, L'Oreal, Unigen Inc, Estee Lauder, Pfizer, Incyte, Miragen, Biofrontera, and Beiersdorf outside the submitted work. Dr Naik reported grants from AbbVie outside the submitted work and personal fees from 23andMe, and is an unpaid board member of the Hidradenitis Suppurativa (HS) Foundation. Dr Shi reported personal fees from AbbVie and Novartis during the conduct of the study. Dr Hamzavi reported receiving equipment from Lenicura (unpaid) and General Electric and grants from Incyte, Pfizer, L'Oreal, Unigen Inc, Estee Lauder, Beiersdorf, and General Electric outside the submitted work. No other disclosures were reported. Dr Hamzavi is the current president of the HS Foundation (unpaid).