Hidradenitis suppurativa treatment during pregnancy and lactation
Today’s report also covers research into female hirsutism and polycystic ovary syndrome, a rare case of prurigo pigmentosa, and more (1,271 words, 6.2 minutes)
Good morning, and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We’re pleased to have you join us. This biweekly bulletin will update you on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them. We welcome your feedback and opinions, so let us know if you have any comments, observations, or suggestions. You can email them to us at health@chronicle.org
A study in the International Journal of Dermatology (Jan. 31, 2025) analyzed the management of hidradenitis suppurativa (HS) during pregnancy and lactation, highlighting the unique challenges faced by women with this chronic inflammatory skin condition. According to the study, HS predominantly affects young adults, particularly females, and often emerges during reproductive age. The study revealed that HS management during pregnancy and lactation presents significant challenges, with variable disease activity, limited treatment options, and potential impacts on pregnancy outcomes and breastfeeding. The authors emphasize the need for tailored management strategies for these patients.
For this study, the authors conducted a systematic literature review focusing on the management of HS in pregnant and lactating women. They searched multiple databases for studies containing original patient data on this topic. They then analyzed the findings from the selected studies, synthesizing information on disease activity during pregnancy and postpartum, treatment challenges, and the safety profiles of various management options. They also examined the impact of HS on pregnancy outcomes and breastfeeding.
The researchers found that the course of HS during pregnancy is variable, with approximately 40% of women experiencing symptom relief and others facing worsening symptoms, especially in the third trimester. Notably, nearly 70% of women experience postpartum flares. Factors such as weight gain, increased adipose tissue, and hormonal fluctuations are considered potential triggers for flares. Furthermore, HS during pregnancy is also associated with higher risks of complications, including spontaneous abortion, gestational hypertension, and c-sections.
In terms of management, the study highlighted that most treatment options for HS during pregnancy and lactation are limited due to safety concerns, particularly with oral antibiotics, antiandrogens, and retinoids. Topical treatments, such as clindamycin and antiseptic washes, are preferred for mild cases since they have minimal systemic absorption and are generally considered safe during pregnancy and breastfeeding. Topical resorcinol also showed promising results for treating mild HS, though safety data during pregnancy and lactation is limited.
Regarding systemic treatments, the authors write that oral clindamycin and rifampicin, often combined, show moderate effectiveness in managing HS. However, rifampicin poses potential teratogenic risks, which may lead to recommendations for clindamycin alone in pregnant patients. Dapsone, while effective for some, is not a first-line therapy due to safety concerns during pregnancy. Intravenous ertapenem is used for severe, treatment-resistant cases but is associated with concerns over antimicrobial resistance and limited data on its safety during breastfeeding.
The study also found that biologic agents offer promise for refractory HS cases, particularly TNF-alpha inhibitors such as adalimumab, infliximab, and certolizumab pegol. Adalimumab is generally safe during pregnancy but should be discontinued after 20 weeks to reduce fetal exposure. Infliximab does not significantly increase pregnancy risks but may affect the timing of live vaccines in infants. Certolizumab pegol has minimal placental transfer and is considered safe throughout pregnancy. All three are generally considered safe during breastfeeding, with minimal drug transfer into breast milk.
The Takeaway: The study found that HS during pregnancy is associated with higher risks of complications such as spontaneous abortion. Treatment options for HS during pregnancy and lactation are limited due to safety concerns, with topical treatments such as clindamycin and antiseptic washes preferred for mild cases, while systemic therapies, including rifampicin and dapsone, pose teratogenic risks. The authors emphasize the need for tailored management strategies for pregnant and breastfeeding patients.
Prevalence of female hirsutism and polycystic ovary syndrome
Research in the Journal der Deutschen Dermatologischen Gesellschaft investigated demographic disparities in hirsutism prevalence among women in the United States. The researchers found that hirsutism prevalence was significantly higher in women with polycystic ovary syndrome (PCOS) than in women without PCOS.
For this study, the authors conducted a cross-sectional analysis using the “All of Us” database, examining 172,401 women, and calculated prevalence rates and odds ratios for hirsutism in different demographic groups. The findings showed that Black women experienced elevated rates of hirsutism, while Asian and Hispanic women exhibited lower rates. Additionally, higher levels of education and income were linked to an increased likelihood of hirsutism.
Causes and complications of artificial depigmentation in women
A study in Research Journal for Social Affairs explored the motivations and consequences of artificial depigmentation among women in the Boukoki II district of Niamey in Niger. The researchers found that the main complications of artificial depigmentation included dermatophyte infections, acne, and stretch marks, with no systemic pathologies reported.
For this study, 90 women practicing depigmentation were surveyed, and healthcare workers documented any complications. The most used products contained hydroquinone, corticosteroids, and, less commonly, mercury and glutathione. The results showed that women engaged in artificial depigmentation primarily to enhance beauty, attract men, and follow fashion trends.
Comparative efficacy of oral vitamin D, topical minoxidil, and their combination in treating female pattern hair loss
A study published in the Research Journal for Social Affairs compared the effectiveness of topical minoxidil, vitamin D supplementation, and their combination in treating female pattern hair loss (FPHL). The researchers found that combination therapy with topical minoxidil and vitamin D supplementation significantly improved hair density and serum vitamin D levels compared to either treatment alone.
For this study, 81 female patients with FPHL were divided into three groups: Group One received 2% topical minoxidil with oral vitamin D, Group Two received minoxidil alone, and Group Three received vitamin D alone. The results showed that the first group showed the most significant improvements.
Facial skin quality improvement after treatment with CPM-HA20G
A Journal of Cosmetic Dermatology study investigated the effectiveness and safety of CPM-HA20G, a hyaluronic acid filler with glycerol, in Korean women. The researchers found that CPM-HA20G significantly improved skin glow, firmness, surface evenness, and tone evenness in Korean women with no serious adverse reactions.
For this study, 20 participants received intradermal injections over three sessions at four-week intervals, with follow-ups at 12 and 24 weeks. The results showed significant improvements in overall skin appearance and reduced transepidermal water loss.
VIDEO: The Itch You Can’t Scratch. Vulvar Itching, Lichen Sclerosus
Chicago-based gynecologist Dr. Sameena Rahman discusses how to deal with itching related to vulvar lichen sclerosus.
A rare case of prurigo pigmentosa in sisters
A case report in Clinical Case Reports described an 18-year-old woman and her 30-year-old lactating sister who both presented with itchy skin lesions on their chests and backs. The younger sister had recurrent flare-ups for over a year, while the elder developed lesions one month postpartum. Both patients had normal metabolic panels. Biopsies showed features consistent with prurigo pigmentosa. The younger sister was treated with 50 mg of daily minocycline, and the elder with 250 mg of daily azithromycin due to breastfeeding. After one month, the younger sister showed better improvement. The older sister reported spontaneous improvement one month after stopping lactation. Whitening creams were prescribed for residual hyperpigmentation.
“Bioidentical pellet treatment [a hormone therapy using plant-derived compounds] works in the body to release a consistent dose of hormones, helping to balance those hormone levels and in turn promote collagen production, boost skin hydration and improve elasticity. By addressing the hormonal root cause of menopausal skin changes, bioidentical pellets can effectively, ‘turn back the clock,’ on aging skin.”
— Dr. Kim Nichols, a Greenwich, Conn.-based dermatologist in an interview with Parade Magazine.
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