Hidradenitis Suppurativa from Preconception to Lactation: Clinical Treatment Decision-Making Review

Hidradenitis suppurativa is a chronic, inflammatory skin disease that predominantly affects women of reproductive age and may require continuous therapeutic control during pregnancy and lactation. This review summarizes current evidence on the safety and practical use of topical, systemic, biologic, metabolic, and procedural therapies for HS throughout the preconception, gestational, peripartum, and breastfeeding periods. Topical clindamycin, benzoyl peroxide, chlorhexidine, and selected beta-lactam antibiotics appear to represent preferred options for mild disease or acute flares, whereas tetracyclines, retinoids, spironolactone, apremilast, Janus kinase inhibitors, and most glucagon-like peptide-1 (GLP-1) receptor agonists require avoidance or discontinuation because of fetal or neonatal safety concerns. Among biologics, tumor necrosis factor-α inhibitors remain the best-characterized agents, with certolizumab pegol offering minimal placental transfer and adalimumab or infliximab requiring individualized decisions regarding continuation and timing of discontinuation. Evidence for newer agents, including secukinumab and bimekizumab, is evolving but remains more limited. The review also highlights the importance of preconception counseling, medication transition, multidisciplinary delivery planning, postpartum flare prevention, breastfeeding-compatible therapy, and individualized procedural management. The management considerations presented herein are intended to support individualized clinical decision-making and should not be interpreted as formal guideline recommendations. Graphical abstract available for this article.