Pregnancy and HS: What to Expect and How to Cope

Pregnancy is a life-changing journey filled with emotional highs, physical changes, and lots of uncertainty. For individuals living with Hidradenitis Suppurativa (HS), it can also bring a unique set of challenges. HS is a chronic inflammatory skin condition that causes painful nodules, abscesses, and tunneling under the skin, typically in areas like the armpits, groin, and under the breasts. Managing HS is already complicated—but throw pregnancy into the mix, and things can feel overwhelming.

If you’re pregnant or planning to become pregnant while living with HS, it’s completely natural to have questions. Will your symptoms get worse or better? Are your medications safe during pregnancy? Will labor and delivery be more difficult if you have lesions in sensitive areas? How will you cope with the physical and emotional toll of both pregnancy and HS flares at the same time?

The truth is, pregnancy affects everyone differently—and HS is no exception. Some people experience a reduction in flare-ups during pregnancy, likely due to hormonal shifts, while others see an increase in symptoms. Hormonal fluctuations, immune system changes, weight gain, and increased moisture or friction in skin folds can all play a role in how your HS behaves during this time. Beyond the physical symptoms, there are also emotional concerns, from body image struggles to fears about parenting with a chronic condition.

The good news is that you don’t have to navigate this alone. With proper planning, support, and medical guidance, many people with HS go on to have healthy pregnancies and manage their symptoms effectively along the way.

In this article, we’ll explore:

How HS may change during pregnancy
What treatments are considered safe while pregnant or breastfeeding
Coping strategies for physical and emotional challenges
Tips for preparing for delivery and postpartum care

Your experience may not be perfect—but it can still be empowering, informed, and full of support.

How HS May Change During Pregnancy

Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin condition that affects the areas where skin rubs together—like the underarms, groin, buttocks, and under the breasts. It’s often painful, persistent, and emotionally draining. When pregnancy enters the picture, many people with HS worry about how their symptoms might change, whether treatments will still be safe, and how their body will respond to the hormonal shifts that come with carrying a child.

Unfortunately, HS during pregnancy isn’t entirely predictable. Some individuals experience improvement during pregnancy, while others report flare-ups that are more frequent or intense. Understanding the factors at play can help you prepare for what’s ahead—and work with your healthcare team to manage symptoms safely and effectively.

How HS Might Improve During Pregnancy

For some pregnant individuals with HS, symptoms lessen or even go into temporary remission. This may be due to hormonal changes—particularly the increase in estrogen and progesterone—that can lead to a more stable immune response and less skin inflammation.

The immune system also shifts during pregnancy to accommodate the growing fetus. Since HS is an immune-mediated condition, these changes can alter the way the body responds to inflammation. For some, this results in fewer or milder lesions during pregnancy, particularly in the second and third trimesters.

This improvement is not guaranteed, but it’s certainly a possibility—and a hopeful one for many expectant parents.

How HS Might Worsen During Pregnancy

On the other hand, many others report that their HS symptoms worsen during pregnancy, especially in the early stages. Increased sweating, hormonal fluctuations, and weight gain (which can lead to added friction and moisture in skin folds) may trigger more frequent flare-ups.

Common triggers during pregnancy include:

Hormonal changes, especially in the first trimester
Increased skin friction due to body changes and weight gain
Stress and fatigue, which are both common during pregnancy and can impact immune health
Limited mobility or changes in hygiene routines, especially as the belly grows

Additionally, the limitations on certain medications during pregnancy can make managing HS more difficult, especially for those who rely on stronger systemic treatments. That’s why creating a care plan with your healthcare provider early on is essential.

What Treatments Are Considered Safe While Pregnant or Breastfeeding

Pregnancy changes everything—including how you manage chronic conditions like HS. Not all treatments are considered safe during pregnancy or while breastfeeding, so it’s important to review your current medications and wound care routine with your healthcare provider as soon as possible, preferably before conception if you’re planning to become pregnant.

Below is a breakdown of common HS treatments and their general safety during pregnancy and lactation. Always consult your obstetrician and dermatologist before starting or continuing any treatment.

Topical Treatments

Topical therapies are generally considered safer than systemic medications during pregnancy because they are applied to the skin and absorbed in lower quantities. These include:

Topical clindamycin: This antibiotic gel or lotion is commonly used to manage mild HS and is considered relatively safe during pregnancy. It helps reduce bacteria and inflammation in affected areas.
Antibacterial washes: Cleansers with chlorhexidine, benzoyl peroxide, or zinc pyrithione are often recommended for daily hygiene. While some ingredients should be used with caution, most topical antibacterial soaps are safe if not overused.
Zinc-based barrier creams: These can help prevent chafing and protect sensitive skin. They’re safe to use and often helpful for managing HS discomfort.

Avoid: Topical retinoids (such as tretinoin), as they may pose risks during pregnancy.

Systemic Antibiotics

For moderate to severe HS, systemic (oral) antibiotics are often prescribed to reduce inflammation and treat infection. However, not all are safe during pregnancy.

Safe options may include erythromycin (in certain forms) and cephalexin, both of which have a long history of use during pregnancy.
To avoid: Tetracyclines (like doxycycline or minocycline), especially after the first trimester, due to potential effects on fetal bone growth and teeth discoloration.

Your doctor will weigh the risks and benefits before prescribing any systemic antibiotics, and treatment should be carefully monitored.

Biologic Medications

Biologic therapies, such as adalimumab (Humira), have been approved for use in HS and are among the more advanced treatment options for moderate to severe cases. Their safety during pregnancy is a nuanced topic.

Adalimumab falls under FDA pregnancy category B, which means that animal studies have not demonstrated a risk, but human studies are limited. Some women have continued using it during pregnancy with their doctor’s approval, especially if HS is severe and disabling.
Biologics may be discontinued during the third trimester, as they can cross the placenta in greater amounts later in pregnancy.

If you are already on a biologic, talk to your dermatologist and OB-GYN about the risks and whether to continue or pause treatment during pregnancy.

Steroid Injections

Intralesional steroid injections—corticosteroids injected directly into a lesion—can reduce swelling and pain from HS flares. These are generally considered safe in small, localized doses during pregnancy but should be used sparingly and under close supervision.

Systemic steroids (like prednisone) may be used in severe cases, but only when necessary, and typically at the lowest effective dose for the shortest time possible.

Pain Management

Pain is one of the most distressing symptoms of HS. Managing it during pregnancy, however, must be done carefully.

Acetaminophen (Tylenol) is the preferred first-line option for pain relief during pregnancy.
NSAIDs like ibuprofen should be avoided in the third trimester and used with caution earlier in pregnancy.

Always talk to your healthcare provider before taking any pain medication—even over-the-counter ones.

Wound Care and Skincare During Pregnancy

Basic wound care becomes even more important during pregnancy, when your skin may be more sensitive and prone to infection. Tips include:

Daily gentle cleansing with non-irritating soap
Warm compresses to soothe flares
Sterile dressings or pads for draining lesions
Loose, breathable clothing to reduce friction

Increased sweating during pregnancy may worsen HS, so moisture control with powders or moisture-wicking fabrics can be helpful.

Breastfeeding Considerations

If you plan to breastfeed, it’s important to consider where your HS flares occur and how treatments may impact milk supply or transfer to the baby.

Many topical treatments are still considered safe, especially if they are not used near the breast area.
Systemic antibiotics must be chosen carefully—some may pass into breast milk, though often in small amounts.

Always inform your doctor and pediatrician about any medications you’re taking while breastfeeding. You may also want to speak with a lactation consultant if HS lesions affect the breast or underarm area, as this can make breastfeeding more painful or logistically difficult.

In Summary

Managing HS during pregnancy and breastfeeding requires thoughtful planning, clear communication with your care team, and a willingness to adjust your treatment plan as your body changes. While some people find relief from symptoms during pregnancy, others may experience flare-ups that require special care.

The key is working with your OB-GYN, dermatologist, and, when needed, a pediatrician or lactation expert to ensure you’re using treatments that are both effective and safe for you and your baby. With the right support, you can confidently navigate pregnancy and early parenthood while continuing to care for yourself and your skin.

Coping Strategies for Physical and Emotional Challenges During Pregnancy with HS

Pregnancy brings with it a host of physical changes and emotional ups and downs, and when you’re also living with Hidradenitis Suppurativa (HS), the experience can feel doubly overwhelming. Between body discomfort, anxiety about flare-ups, worries about your baby’s health, and the unpredictable course of HS during pregnancy, coping becomes not just helpful—it becomes essential.

The good news is that there are many strategies, both physical and emotional, to help you get through pregnancy with HS more comfortably and confidently.

Physical Coping Strategies

1. Dress for Comfort and Skin Protection

As your body grows during pregnancy, areas prone to HS flare-ups—such as underarms, inner thighs, under the breasts, and groin—can become even more irritated due to added friction, sweating, and pressure. Prioritize breathable, loose-fitting clothing and undergarments.

Cotton or bamboo fabrics are gentle on sensitive skin and help reduce moisture.
Seamless underwear and bralettes can prevent rubbing against flare-prone areas.
Anti-chafing creams or powders like cornstarch or zinc-based products can reduce skin-on-skin irritation.

Wearing the right clothing not only helps physically but can also improve your confidence and body comfort.

2. Use Cool Compresses and Warm Showers

During flares, applying cool compresses can reduce inflammation, while warm showers or sitz baths can soothe pain and help clean affected areas gently. These small rituals can become part of your daily routine for comfort and wound management.

3. Modify Movement and Activities

If HS flares affect your ability to walk, sit, or lie down comfortably, adjust how you move through the day:

Use pregnancy pillows to cushion pressure points and support your belly and thighs.
Alternate between sitting and lying on your side to reduce irritation.
Keep a soft cushion or donut pillow nearby to ease sitting during flares.

Listen to your body, and avoid pushing yourself through unnecessary discomfort.

4. Practice Gentle Hygiene

Hygiene is important, especially during pregnancy when immune function is more delicate. But over-washing or using harsh products can irritate HS-prone skin.

Use fragrance-free, gentle cleansers, and limit washing to once or twice daily.
Gently pat your skin dry rather than rubbing.
Apply barrier ointments or zinc oxide cream if you expect sweating or friction.

If wounds are open or draining, consult your provider for wound care supplies and instructions.

Emotional Coping Strategies

1. Acknowledge Your Feelings

Living with HS is already emotionally taxing. Adding pregnancy, body image changes, hormonal shifts, and concerns about the future can amplify anxiety and depression. It’s important to acknowledge your feelings without judgment.

You may feel:

Fear about how HS will affect delivery
Frustration about pain or physical limitations
Shame or embarrassment about visible lesions
Worry about being a good parent while managing a chronic illness

These emotions are valid. Allow yourself to feel them—and then seek the support you deserve.

2. Connect With a Mental Health Provider

If feelings of depression or anxiety become overwhelming, speak with your OB-GYN about seeing a therapist or counselor, especially one who works with chronic illness or maternal mental health. Pregnancy is a vulnerable time, and mental wellness is critical—for you and your baby.

Many mental health professionals now offer telehealth sessions, which can be especially helpful if mobility is limited due to HS or pregnancy.

3. Build a Support Network

Don’t try to manage HS and pregnancy alone. Lean on:

Your partner or close family/friends for help with physical tasks or emotional support
Online or in-person HS communities, especially those focused on parenting or pregnancy
Pregnancy support groups, even if they’re not HS-specific, for encouragement and solidarity

Sometimes, simply knowing that others are going through something similar can ease the emotional burden.

4. Practice Self-Compassion

There may be days when you feel like your body is failing you or that you’re not doing “enough.” Remind yourself that managing a chronic condition while growing a human is a profound accomplishment.

Be gentle with yourself. Celebrate small victories, take breaks without guilt, and focus on what you can do instead of what you can’t.

Tips for Preparing for Delivery and Postpartum Care with HS

Planning ahead for labor, delivery, and the postpartum period can help reduce stress and ensure you have the right support in place when the time comes. With HS, a few extra considerations can go a long way in making recovery smoother and more manageable.

1. Talk to Your OB-GYN and Dermatologist About Delivery Options

If you have HS lesions in the groin, inner thighs, or perineal area, speak openly with your OB-GYN about how this may impact your delivery plan.

Vaginal delivery is still possible for most people with HS, but active or severe lesions may require special care during labor.
C-sections may be considered if lesions are extensive or if there are other complications, but they also carry risks for scarring and wound healing—which can be complicated by HS.

Your provider may consult a dermatologist or wound care specialist if necessary.

2. Prepare a Postpartum Wound Care Kit

After delivery, you’ll need to care for both HS flare areas and your postpartum healing zones. Stock a kit with essentials like:

Non-stick wound dressings
Sterile saline spray or wound cleanser
Clean gauze and paper tape
Zinc ointment or diaper cream
Pain relief pads (safe for perineal use)
Fragrance-free cleansing wipes

If you’re breastfeeding and have HS lesions near the breasts or underarms, consult with a lactation consultant to find comfortable feeding positions and protective skincare.

3. Plan for Extra Help at Home

Newborn care is exhausting, even without a chronic condition. Arrange for help with:

Cooking and cleaning
Changing wound dressings or helping with mobility
Caring for the baby during HS flares

This could be a partner, family member, friend, or a professional postpartum doula. Accepting help is not a sign of weakness—it’s a smart strategy for preserving your health and energy.

4. Monitor Postpartum Hormonal Changes

After childbirth, hormones shift dramatically. Some people experience a return or worsening of HS symptoms in the weeks and months following delivery.

Keep a symptom diary and speak with your doctor about:

Adjusting medications or resuming treatments that were paused during pregnancy
Flare prevention strategies
Safe options while breastfeeding

Hormonal birth control may be discussed as a future option to stabilize hormone-driven flares—your provider can recommend methods based on your postpartum and breastfeeding plans.

5. Be Patient With Healing and Recovery

The postpartum period is one of transformation. Your body is healing from pregnancy, delivery, and possibly HS flares. Your emotions may be raw, and your energy stretched thin.

Give yourself time to recover—physically, emotionally, and mentally. Healing takes time, and it’s okay if you need extra support along the way. You are doing an incredible job, and your health matters just as much as your baby’s.

In Summary

Pregnancy with HS presents challenges, but it also offers an opportunity to reconnect with your strength, find support, and take a proactive approach to self-care. With thoughtful planning, honest communication with your care team, and kindness toward yourself, you can manage HS while embracing the journey into parenthood. Every body, every pregnancy, and every HS experience is different—but you are not alone. There’s support, guidance, and hope at every step.

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