Table 2.

Flare management in pregnant patients with hidradenitis suppurativa

First line: warm baths and compresses, antiseptic washes, and topical clindamycin [122]

Systemic antibiotic(s) such as clindamycin, amoxicillin-clavulanic acid, metronidazole, cephalexin, or cefdinir can be given as short courses (2–3 weeks) for acute flares, or as longer courses (2–3 months) as a bridge to delivery or more sustainable long-term therapies

Oral corticosteroid (prednisolone or prednisone 40 mg tapered by 10 mg every 3 days) taper alone or in combination with amoxicillin-clavulanic acid [27]

Intralesional triamcinolone injections (10–40 mg/mL, maximum 40 mg total) for acutely inflamed inflammatory nodules or tunnels [122]

Incision and drainage for acutely painful and/or expanding abscesses; lesions should be adequately anesthetized prior to incision

Deroofing procedures with local anesthesia may be considered on a case-by-case basis

Avoid larger excisions that require general anesthesia

When an anesthetic is required (i.e., incision and drainage, deroofing procedures), plain lidocaine is preferred over lidocaine with epinephrine [120]

Analgesic use: acetaminophen preferred during pregnancy and ibuprofen during breastfeeding [122]