33801 Women of childbearing age with hidradenitis suppurativa frequently prescribed medications dangerous for pregnancy

Abstract

Introduction: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing age. In a survey of female HS patients of reproductive age, 83% reported not receiving counseling from their physician on how HS and their prescribed medications could impact childbearing. Methods: We used the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2018, the most recent years available, to quantify the treatment modalities most commonly being used for HS in women of childbearing age. Results: Oral clindamycin was the most commonly prescribed drug, followed by minocycline, trimethoprim-sulfamethoxazole (TMP-SMX), acetaminophen-oxycodone, and doxycycline. Minocycline and doxycycline are pregnancy category D and TMP-SMX and acetaminophen-oxycodone are pregnancy category C. Medications such as isotretinoin, acitretin, alitretinoin, and adalimumab were not referenced in the dataset. Discussion: As half of pregnancies in the United States are unplanned, dermatologists must consider medication safety when managing patients in this population. Oral clindamycin is not recommended unless clearly needed in the first trimester of pregnancy due to lack of data. Minocycline, doxycycline, and TMP-SMX are all well known to cause teratogenicity. It is encouraging that dermatologists are not prescribing drugs that have no indication for use during pregnancy but with relatively higher levels of efficacy evidence such as isotretinoin or alitretinoin. With the Food and Drug Administration approval of adalimumab for HS in 2018 and the increasing evidence supporting the use of biologics in HS, research should be done in order to ensure dermatologists are prescribing these medications, which are safer and more effective alternatives for women of childbearing age.