Table 1.

Hidradenitis suppurativa treatments and their compatibility with pregnancy and lactation

Recommendationa	Pregnancy	Lactation
Generally considered compatible	Topical therapies Benzoyl peroxide wash [9] Chlorhexidine wash [13] Clindamycin [9] Systemic antibiotics Clindamycin [26] Amoxicillin-clavulanic acid [29, 30] Metronidazole [32] Cephalexin [36] Cefdinir [36] Metabolic/hormonal/oral retinoids Metformin [56] Biologics Certolizumab [71] Supplements Zinc [113]	Topical therapies Benzoyl peroxide wash [11] Chlorhexidine wash [14] Clindamycin [11] Systemic antibiotics Clindamycin [26] Amoxicillin-clavulanic acid [31] Cephalexin [38] Cefdinir [38] Rifampin [18] Metabolic/hormonal/oral retinoids Metformin [46, 57] Spironolactone [60] Biologics Certolizumab [72] Adalimumab [84] Infliximab [84] Supplements Zinc [115]
Use with caution	Systemic antibiotics Dapsone [42] Rifampin [45] Ertapenem [50] Biologics Adalimumab [76] Infliximab [76] Secukinumab [87] Ustekinumab [89] Bimekizumabc [92] Immunosuppressants Corticosteroids [103] Cyclosporine [111]	Topical therapies Clascoterone [18, 23] Systemic antibiotics Metronidazole (stop breastfeeding for 12–24 hours after taking dose) [34, 55] Dapsone [18] Ertapenem [50] TMP-SMX (limit use in infants <2 months) [55] Metabolic/hormonal/oral retinoids OCPs [18] GLP-1 agonists [66] Biologics Secukinumab [84] Ustekinumab [83] Bimekizumab [93] Anakinra [18, 96] Immunosuppressants Corticosteroids (wait 4 hours after dose to breastfeed) [107] Cyclosporine [18]
Avoid use	Topical therapies Resorcinolb [19] Ruxolitinibb [21] Clascoterone [23] Systemic antibiotics Tetracyclines [51] Fluoroquinolones [127] TMP-SMX [51] Metabolic/hormonal/oral retinoids Spironolactone [58] OCPs [128] GLP-1 agonists [64] Retinoids [67] Biologics Anakinra [94] Small-molecule inhibitors Apremilast [98] Upadacitinib [102]	Topical therapies Resorcinolb [18] Ruxolitinibb (do not breastfeed for at least 4 weeks after topical use) [21] Systemic antibiotics Tetracyclinesb (may consider a ≤21-day course if needed) [18] Fluoroquinolonesb [127] Metabolic/hormonal/oral retinoids Retinoids [60] Small-molecule inhibitors Apremilastb [11, 98] Upadacitinibb (do not breastfeed for at least 6 days after last dose) [102]

GLP-1 glucagon-like-peptide-1, OCPs oral contraceptive pills, TMP-SMX trimethoprim-sulfamethoxazole

^aEach patient’s treatment plan should be individually tailored to account for their comorbidities, preferences, and personal risk factors

^bRecommend to avoid use if possible because of inadequate human and animal data

^cGenerally recommend to avoid use in pregnancy if possible due to inadequate human data, however, animal data show no harm; can be considered with extreme caution on a case-by-case basis