Menses and pregnancy affect symptoms in hidradenitis suppurativa: A cross-sectional study

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations

“…Androgens influence HS, as evidenced by the effects of pregnancy and menstrual cycles for many patients, 98,99 but the recommendations on hormonal therapies are based on limited evidence (Table IV).…”

“…Although it has not been studied, expert opinion indicates that HS severity may improve, 99,118 worsen, or be unaffected by pregnancy. 119 Treatment of HS in pregnant women requires special consideration of medication effects on the developing embryo.…”

Hidradenitis Suppurativa: Current Understanding of Pathogenic Mechanisms and Suggestion for Treatment Algorithm

“…This is primarily based on a number of clinical observations and promising effects of antiandrogen treatments. For instance, some female HS patients observe worsening of disease in conjunction with menstruation or after starting hormonal contraception with androgen effects (e.g., progesterone-containing drugs) (47,54). Hormones can induce occlusion and plugging of the follicle and increase production and composition of sebum, thereby contributing to the vicious cycle of HS skin inflammation (55,56).…”

British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018

“…The significant inflammatory response seen in HS has led some to speculate that it may be a disease of aberrant immunity and it is noteworthy that immunomodulatory treatments including anti‐TNF agents can be of benefit . The female predominance, post‐pubertal onset, premenstrual flares and clinical improvement often observed during pregnancy imply a role for hormones in HS; however, the mechanism remains unknown . The role of bacteria in exacerbations is uncertain, for example short courses of antibiotics do not seem to alter the natural history of a flare .…”