Impact of Psoriasis and Hidradenitis Suppurativa in Pregnancy, a Systematic Review

Abstract

Psoriasis and hidradenitis suppurativa (HS) are chronic inflammatory skin diseases that frequently develop in young women. The aim of this study is to evaluate how hidradenitis suppurativa and psoriasis impact women desiring to conceive, and their influence on fertility and gestation. A systematic review of articles dating from January 2015 to April 2021 was performed using the Scopus (Elsevier) database. The search terms were (psoriasis and (birth or pregnancy or fertility)) and ((hidradenitis suppurativa or acne inversa) and (birth or pregnancy or fertility)). The search was limited to human data. Systematic reviews, case reports, clinical practice guidelines, expert consensus and conference papers were excluded. The impact of HS on pregnancy includes an impaired desire for pregnancy, a decrease in fertility, the worsening of the disease during pregnancy and potential adverse events during pregnancy. Moreover, the pregnancy might imply a change on the treatment of HS. The impact of psoriasis on pregnancy includes a decrease in fertility, potential adverse events during pregnancy and an unpredictable evolution of the disease. Moreover, the pregnancy might imply a change on the treatment of psoriasis, although biologic therapies do not appear to increase the risk of adverse events. In conclusion, both HS and psoriasis have an impact on pregnancy. A decrease of fertility has been reported. Moreover, both diseases have an unpredictable evolution during pregnancy. Pregnant women who are under biologic therapy do not seem to have a higher rate of adverse events. Treatment of both conditions is usually halted during pregnancy since scientific evidence about their safety is not conclusive, or teratogenic risk has been proven.

Effectiveness and Safety of Acitretin for the Treatment of Hidradenitis Suppurativa, Predictors of Clinical Response: A Cohort Study

“…Moreover, the rate of adverse effects of acitretin treatment is shown to be low, and they are not a cause for discontinuing treatment. This fact makes it a treatment with potential application, except in women of childbearing age with unsatisfied reproductive desires [28, 29].…”

Biologic drugs in hidradenitis suppurativa: what does the GP have to know? A narrative review

“…However, an individualized risk benefit discussion should be had with patients regarding treatment ( 67 ). Pregnancy in HS is a sensitive topic and should be approached with the patient with caution, as HS can lead to decreased fertility, and adverse reactions during pregnancy, as well as gestation triggering a clinical worsening of the disease ( 68 ). Therefore, biologic treatments in pregnancy should be discussed with patients of childbearing potential.…”

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits

“…Physiological changes during pregnancy may have a variable impact on HS course [ 142 ]. A recent systematic review and meta-analysis (including 8 studies [ 53 , 143 , 144 , 145 , 146 , 147 , 148 , 149 ], 672 pregnancy cases and 164 postpartum cases) found that the patient-reported rates of HS improvement and HS disease worsening were 0.24 and 0.20, respectively.…”