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HS during pregnancy and after birth: what to expect and what helps
HS can improve or flare during pregnancy and after birth. Learn which hidradenitis suppurativa treatments are often used safely and when to call your doctor.
Key takeaways
HS symptoms can improve, remain stable, or worsen during pregnancy. Flares are also common after delivery, so it helps to plan for continued care.
If antibiotics are not controlling your HS, contact your dermatologist and obstetric team to review your treatment. Do not stop or change prescribed medication without medical guidance.
Pregnancy does not mean putting HS treatment on hold. Several options may be appropriate, and reviewing medications before conception can help you plan safely.
Fever, rapidly spreading redness, or worsening swelling need prompt medical assessment, especially during pregnancy or after delivery.
Breastfeeding is possible for many people with HS. Your dermatologist can help manage breast-area symptoms and review medication compatibility.
If antibiotics aren't controlling your HS while you're pregnant, keep taking your current medicine and contact your dermatologist and obstetric team. Tell them what has changed, such as new lumps, more pain, or drainage. Then ask whether your plan can shift to other options that are often considered compatible with pregnancy.
Those options can include a different antibiotic, a topical treatment or antiseptic wash, or a steroid injection directly into a painful lump. A tense, painful abscess may need drainage. For moderate to severe HS, a biologic, a medicine that targets specific immune signals behind the inflammation, may also be worth discussing.
Get care right away for a fever or redness that spreads quickly. It's understandable to worry about your baby. Many treatments for hidradenitis suppurativa can be used during pregnancy.
How pregnancy can change HS
HS can improve, stay the same, or worsen during pregnancy, and the pattern can differ from one pregnancy to the next. In a review of HS in pregnancy, a meta-analysis of eight studies found HS improved in 24% of people and worsened in 20%. Most people had continued disease activity, based on what patients reported.
The same review notes that hormones are thought to play a role, though the exact reason is not established. Separately, a growing belly and new skin folds can add friction where HS often appears. Because HS usually stays active, most people need a plan that continues through pregnancy, and our hidradenitis suppurativa guide covers HS treatment in general.
If you're planning a pregnancy
Review your HS medicines with your dermatologist before you start trying to conceive. Some common HS medicines are usually stopped or switched before pregnancy. These include tetracycline antibiotics such as doxycycline or minocycline, spironolactone, and oral retinoids, which are vitamin A-based pills such as isotretinoin.
Switching early gives your dermatologist time to move you to a pregnancy-compatible plan while your HS is stable. It also gives you time to ask questions before anything feels urgent. If you take a biologic, ask how it fits into your pregnancy plan.
Some people are unsure which HS treatments remain available during pregnancy. In a 2026 survey of women with HS, the most common barrier to care in pregnancy and breastfeeding was believing nothing could be done (31.6%). In the same survey, 18.2% said they couldn't find a clinician knowledgeable about HS treatment during pregnancy.
These responses were self-reported, but they highlight the importance of discussing treatment options early rather than assuming care must stop.
Many pregnancies are unplanned. If you learn you're pregnant while taking an HS medicine, call your dermatologist and obstetrician promptly. They can tell you which medicines to pause, which to switch, and which to keep.
Treatment options to discuss during pregnancy
Many HS treatments can be used during pregnancy. The goal is to keep your HS controlled while protecting your baby. You make each choice with your dermatologist and obstetrician.
A 2026 review of HS treatment lists preferred options for mild disease or flares. These include topical clindamycin, benzoyl peroxide or chlorhexidine washes, and selected beta-lactam antibiotics, the penicillin and cephalosporin families. Tetracyclines, retinoids, and spironolactone are usually avoided.
The same review stresses avoiding unnecessary treatment withdrawal. Uncontrolled HS may carry more risk than continuing a treatment that is working.
The table below groups common options at the class level, drawn from the 2025 and 2026 reviews cited in this article. Use it to prepare questions for your care team. Your doctors will tailor every choice to your HS and your pregnancy.
Often considered compatible | Needs individual review | Usually avoided |
|---|---|---|
Topical clindamycin | TNF-blocker biologics (adalimumab, infliximab, certolizumab) | Doxycycline, minocycline, and other tetracyclines |
Antiseptic washes (benzoyl peroxide, chlorhexidine) | Other biologics | Spironolactone |
Certain oral antibiotics, such as clindamycin or cephalexin | Oral steroids | Oral retinoids (isotretinoin, acitretin) |
Steroid injection into a painful lump | Rifampin | Hormonal birth control used as HS treatment |
Incision and drainage of an abscess | ||
Metformin | ||
Zinc |
Much of this guidance comes from expert review of available data, including experience in other conditions. Studies have not proven how well each option works for HS in pregnant people.
Biologics during pregnancy
For moderate to severe HS, a biologic may be part of the plan during pregnancy. TNF blockers, biologics that block an inflammatory signal called tumor necrosis factor, have the most pregnancy experience.
Adalimumab, infliximab, and certolizumab are TNF blockers. The 2025 review notes that very little certolizumab crosses the placenta. Evidence for it in HS specifically is limited, though, and its use for HS is off-label.
Timing late in pregnancy is a decision for you and both doctors. The 2026 review says it should be individualized rather than based on a single week of pregnancy, and expert groups give different advice. Make any change to a biologic together with them, never on your own.
If you take a biologic late in pregnancy, tell your baby's pediatrician. The 2026 review notes that this can affect the timing of some live vaccines for your baby, and the pediatrician will plan around it.
What to do if antibiotics aren't working while you're pregnant
When an antibiotic course isn't helping, the next step is usually a change in plan while treatment continues. HS is a chronic inflammatory skin condition, not simply an infection, so antibiotics alone may not be enough for some people, and your dermatologist may suggest other treatments. These steps can help you and your doctors find the right adjustment.
Keep taking your current medicine until your doctor advises otherwise.
Contact your dermatologist and let your obstetric team know. Describe new lumps, pain, drainage, where they appear, and any fever.
Ask whether your antibiotic is one usually avoided in pregnancy, such as doxycycline or minocycline. Ask whether a different pregnancy-compatible antibiotic makes sense.
Ask about adding a topical treatment or an antiseptic wash.
Ask about a steroid injection directly into a single painful lump.
Ask about incision and drainage for a tense, painful abscess. This procedure opens the abscess so it can drain.
Ask whether your HS is moderate to severe if flares keep coming. Ask about a biologic or an add-on such as metformin or zinc.
The 2025 review lists a steroid injection into an inflamed lump as a flare option compatible with pregnancy. The 2026 review notes that minor procedures such as incision and drainage can be done during pregnancy after individual assessment. The 2025 review advises avoiding larger surgery that requires general anesthesia during pregnancy, so it is usually postponed when possible.
Before your visit, note when each lump appeared, where it is, and which medicines you've taken. Photos taken between visits can help your dermatologist see how lumps change.
It helps to describe exactly what you're seeing. You might say, "I've been on this antibiotic for a few weeks, and I'm still getting new painful lumps under my arms. What else can we try that's safe for the baby?"
Drainage and injections happen in person. If you see your dermatologist by video, they can arrange that in-person step for you.
Why HS can flare after birth
Flares after birth are common, and they are not caused by anything you did. In a pooled analysis of postpartum flares, 60% of people (99 of 164) reported a flare after delivery. That figure reflects what patients reported, and your own course may differ.
Researchers don't know exactly why flares happen after birth. Hormones may play a role, and medicines paused or changed during pregnancy may need to be restarted or adjusted. Friction from nursing bras or pads can also irritate HS-prone skin.
Before you deliver, plan a postpartum check-in with your dermatologist. Having that visit on the calendar lets you restart or adjust treatment soon after birth. If you have HS in the groin or buttocks, a flare there can make recovery more uncomfortable, which is one more reason to plan ahead.
Breastfeeding with HS
Most people with HS can breastfeed. The MotherToBaby HS fact sheet notes that HS affecting the breast glands, nipple, or areola can make breastfeeding harder. Your dermatologist can suggest treatment that fits with breastfeeding.
If your HS sits near the breast, our article on HS under the breasts explains how HS in that area can affect breastfeeding.
The 2026 review notes that most commonly used HS medicines are compatible with breastfeeding. It also notes that adalimumab, infliximab, and certolizumab pass into breast milk only in negligible amounts. Some medicines need a breastfeeding-specific check, so ask about each one you take.
MotherToBaby also answers questions about specific medicines at 866-626-6847.
Comfort and skin care while you wait to be seen
The 2025 review lists warm compresses and antiseptic washes among the first steps for a flare. A few simple habits can also ease pain and irritation until your visit.
Apply a warm compress to painful lumps.
Wear loose, breathable clothing and maternity wear that doesn't rub skin folds.
Cleanse gently, and ask your dermatologist about an antiseptic wash.
Keep skin folds dry, including under your belly and breasts.
Leave lumps alone rather than squeezing or piercing them.
Choose gentler hair removal options for HS-prone areas.
Ask your obstetric team which pain relievers are appropriate for you.
These steps ease symptoms while you wait. The treatment plan you build with your dermatologist is what addresses the inflammation behind new lumps.
When to get care right away
Some changes need prompt attention during pregnancy and after birth. Contact your care team or seek urgent care if you notice any of these signs:
You have a temperature of 100.4°F (38°C) or higher during pregnancy or in the year after delivery.
You see redness or swelling that spreads quickly, or red streaks.
You notice a lump growing rapidly larger and more painful.
You feel unwell or have chills.
You sense something is wrong, even if it isn't listed here.
The fever threshold comes from the CDC urgent maternal warning signs, which apply during pregnancy and in the year after delivery.
If you notice any of these signs, contact your care team right away, including your obstetric team if you are pregnant or recently gave birth. If you can't reach them, go to urgent or emergency care. Our guide to signs a lump needs prompt care explains red streaks, fever, and when drainage happens in person.
Coordinating your dermatologist and obstetric care
Hidradenitis suppurativa care during pregnancy is shared care. Your dermatologist manages your HS, and your obstetric team manages your pregnancy and delivery. Each team should know what the other is doing.
A 2026 meta-analysis of pregnancy outcomes pooled four retrospective cohorts covering more than 15 million pregnancies. HS was linked with higher odds of gestational diabetes (odds ratio 1.46), preeclampsia or eclampsia (1.18), and cesarean delivery (1.31). An odds ratio above 1 means the outcome was more common in people with HS.
These findings are associations. They do not show that HS causes these outcomes, and they do not mean these outcomes will happen to you. The authors call for coordinated care between dermatologists and obstetricians.
Routine prenatal checks of blood pressure and blood sugar are one more reason to keep both teams informed. A few practical steps keep everyone connected:
Share your full HS history and current medicines with both teams.
Ask your dermatologist to send treatment notes to your obstetric team.
Keep the postpartum dermatology visit you planned before delivery.
Tell your baby's pediatrician about any biologic you took during pregnancy.
Tono's HS specialists see patients by video or in person. Our HS program covers diagnosis, biologic management, treatment escalation, long-term follow-up, and coordination of procedural care such as drainage or injections. Your obstetric team continues to manage your pregnancy and delivery, and Tono's dermatologists work alongside them.
Tono's Chief Medical Officer is Dr. Mondana Ghias, a board-certified dermatologist and recognized authority in HS who has authored more than two dozen peer-reviewed publications, including award-recognized research advancing the treatment of the disease.
Tono has cared for more than 20,000 patients across a 33-state clinical footprint. Our national specialist network is designed to give patients access to dermatologists within days rather than months.
Frequently asked questions
Why did my HS get worse after I had my baby?
Flares after birth are common and are not your fault. Researchers don't know exactly why, but hormones may play a role, and medicines changed during pregnancy may need adjusting. A dermatologist can restart or adjust your treatment, including options compatible with breastfeeding.
Can I keep taking my biologic while pregnant?
It depends on your HS and your stage of pregnancy. The 2026 review advises individual decisions rather than a single cutoff week, and notes that stopping effective treatment can carry its own risks. Make any change with your dermatologist and obstetrician, never on your own.
Is it safe to have an HS abscess drained while pregnant?
Incision and drainage under local numbing medicine is generally considered compatible with pregnancy. It is done in person, and your dermatologist can tell you whether a lump needs it.
Will HS affect how I deliver?
Most people with HS can have a vaginal delivery, according to the 2026 review. Extensive scarring or active HS in the genital area can affect delivery plans. Tell your obstetric team where your HS is so they can plan around it.
Can I see an HS specialist by video while pregnant?
Yes, Tono's HS specialists see patients by video or in person, and much of HS planning and follow-up can happen by video. Ongoing HS care is mostly medical, which is why virtual-first HS care works for many patients. Your specialist coordinates in-person steps such as drainage or injections, and your obstetric team continues your prenatal care.
HS can be treated during pregnancy and after birth, and your plan can change at each stage. A dermatologist experienced in HS can build that plan with you and your obstetric team, and stay with you through breastfeeding and beyond. Schedule an in-person or virtual appointment with a Tono Health specialist.
