Alexis B Lyons1, Anjelica Peacock2, Shanice A McKenzie3, Gordon Jacobsen1, Haley B Naik4, Vivian Y Shi5, Iltefat H Hamzavi1, Jennifer L Hsiao3. 1. Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. 2. Department of Internal Medicine, St Mary Mercy Hospital, Livonia, Michigan. 3. Department of Dermatology, University of California, Los Angeles, Santa Monica. 4. Department of Dermatology, University of California, San Francisco. 5. Department of Dermatology, University of Arizona, Tucson.
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.
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.
Authors: Allard R J V Vossen; Kelsey R van Straalen; Errol P Prens; Hessel H van der Zee Journal: J Am Acad Dermatol Date: 2017-01 Impact factor: 11.527
Authors: Justine R Seivright; Natalie M Villa; Tristan Grogan; Ram K Parvataneni; Alyssa M Thompson; Vivian Y Shi; Jennifer L Hsiao Journal: Dermatology Date: 2021-08-17 Impact factor: 5.366
Authors: Trinidad Montero-Vilchez; Luis Salvador-Rodriguez; Andrea Rodriguez-Tejero; Manuel Sanchez-Diaz; Salvador Arias-Santiago; Alejandro Molina-Leyva Journal: Life (Basel) Date: 2021-03-26