
==== Front
Dermatol Ther (Heidelb)
Dermatol Ther (Heidelb)
Dermatology and Therapy
2193-8210
2190-9172
Springer Healthcare Cheshire

39230800
1249
10.1007/s13555-024-01249-2
Review
A Review of Hidradenitis Suppurativa in Special Populations: Considerations in Children, Pregnant and Breastfeeding Women, and the Elderly
Chung Claire S. 1
Park Sarah E. 2
Hsiao Jennifer L. 3
Lee Katrina H. leekatri@usc.edu

3
1 https://ror.org/03taz7m60 grid.42505.36 0000 0001 2156 6853 Keck School of Medicine, University of Southern California, Los Angeles, CA USA
2 https://ror.org/046rm7j60 grid.19006.3e 0000 0001 2167 8097 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
3 https://ror.org/03taz7m60 grid.42505.36 0000 0001 2156 6853 Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA 90033-9174 USA
4 9 2024
4 9 2024
9 2024
14 9 24072425
28 5 2024
30 7 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
Hidradenitis suppurativa (HS) is a chronic skin condition that significantly impacts patients’ quality of life. HS is often challenging to treat. In this review, we discuss the unique characteristics of HS in four special populations: children, the elderly, pregnant individuals, and breastfeeding mothers. In children, diagnosis may be delayed due to atypical and early HS disease presentations. HS management plans must take into consideration the lack of rigorous efficacy and safety data of HS treatments in this population. However, it is important to weigh the risk of treatments against the risk of untreated HS and the morbidity and mortality risk that having HS confers. Pregnancy poses unique challenges for women with HS, with their condition possibly worsening during pregnancy and increased risk of fetal death. Management strategies during pregnancy must consider both maternal and fetal safety. Similarly, breastfeeding mothers require thoughtful medication selection to balance symptom management with infant safety. In the elderly, HS may present more severely and is often complicated by comorbidities. Treating HS in this population should safely accommodate patients’ additional health conditions. Furthermore, this review highlights the overall paucity of primary literature addressing management in these populations, underscoring the need for further research to optimize HS care across all stages of life.

Keywords

Hidradenitis suppurativa
Pediatric
Pregnancy
Lactation
Elderly
issue-copyright-statement© Springer Healthcare Ltd., part of Springer Nature 2024
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pmcKey Summary Points

Hidradenitis suppurativa (HS) is a chronic skin condition that can have a profound negative impact on patients’ quality of life. Although most prevalent among people in their twenties and thirties, HS can present in adolescence or late adulthood.	
There is currently a lack of population-specific treatment guidelines for HS in children, pregnant and breastfeeding women, and the elderly.	
Management of HS in the pediatric population is largely modeled after adult guidelines and includes treatments such as topical agents, systemic antibiotics, hormonal and metabolic therapies, supplements, retinoids, biologics, small molecule inhibitors, and procedures.	
Although some HS medications should be avoided during pregnancy and lactation, there are medical and procedural treatment modalities that can be safely or cautiously used in these patients.	
Treatment of HS in the elderly should take into consideration the patient’s overall health, comorbidities, potential drug–drug interactions, and goals of care.	

Introduction

Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder characterized by recurrent and painful nodules, abscesses, tunnels, and scarring that typically involve intertriginous areas [1]. Prevalence of HS is reported to be 0.1% in the USA [2] but is likely more common given frequent underdiagnosis and misdiagnosis of this condition. Due to its chronic and debilitating nature, HS can profoundly negatively impact multiple aspects of a patient’s life. Patients with HS experience higher rates of unemployment, disability, pain, substance use, and mental health disparities [1, 3]. Timely diagnosis and intervention are critical in minimizing the burden of disease. Therefore, it is important that clinicians are prepared to diagnose and manage HS in all stages of life. Although HS has been found to be most prevalent among people in their twenties and thirties, up to 50% of patients with HS show symptoms between the ages of 10 and 21 years [4], emphasizing the need for improved early diagnosis of HS in the pediatric population. For a subset of patients, symptoms may manifest in late adulthood. Patients with HS have been found to have a lower life expectancy and higher all-cause mortality; chronic systemic inflammation may play a role [5–7]. Aggressive control of disease is essential, and consequences of untreated HS must be carefully weighed against risks of therapeutic interventions. There is a paucity of data on optimal management of HS in children, pregnant and breastfeeding women, and the elderly. This review discusses HS treatment strategies for the aforementioned special populations. Treatment strategies discussed are based on extrapolation from general HS literature as well as population-specific efficacy data wherever available. HS-specific drug safety data regarding use in these special populations is currently limited, thus safety conclusions also leverage existing literature regarding individual treatments used in these special populations for conditions other than HS. Herein, we aim to update clinicians on a practical approach to management of HS in these patients.

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

HS in Children

HS affects approximately 28 out of 100,000 children and adolescents in the USA. When broken down, HS is quite rare under the age of 10 years and uncommon between ages 10 and 14 years. Of pediatric patients with HS, 72.4% are between the ages of 15 and 17 years [8], though underdiagnosis of HS in younger patients may skew prevalence data. Clinical presentation of HS in children can vary, leading to misdiagnosis and undertreatment of symptoms. Pediatric patients may present with subtle findings such as comedones, papules, pustules, and isolated cysts or abscesses [9]. As such, early disease is often misdiagnosed as acne, folliculitis, or infection. The chronic and recurrent nature of the skin lesions and their tendency to appear in intertriginous regions can help steer clinicians toward a diagnosis of HS. Average time from symptom onset to HS diagnosis is 2.5 years in the pediatric population [9], and up to 7 years in adults [10]. This lag time may contribute to worsening of symptoms and subsequent formation of irreversible skin damage. Clinicians should also assess for co-morbidities including psychiatric conditions (i.e. depression and anxiety), metabolic conditions (i.e. obesity, diabetes), polycystic ovarian syndrome, acne, atopic disease, asthma, and Crohn’s disease [11, 12]. Importantly, it is recommended to screen all patients with Down syndrome for HS given the increased risk of HS in this patient population [13].

Management of HS in the pediatric population is largely modeled after treatment guidelines for adults. There are currently no pediatric-specific HS treatment guidelines, and most systemic treatments are used off label in children, highlighting the need for further work in this area. Commonly utilized medications are listed in Table 1. Table 1 Agents used in pediatric hidradenitis suppurativa

	Treatment	Application/dosing	
Topical agents	Chlorhexidine wash [9]	Daily to HS-affected areas, wash off	
Benzoyl peroxide wash [9]	Daily to HS-affected areas, wash off	
Clindamycin 1% [18]	Once to twice daily	
Resorcinol 15% [18]	Once to twice daily for HS flares	
Systemic antibiotics	Doxycycline (≥ 8 years old) [18]	 ≥ 45 kg: 100 mg PO BID	
Clindamycin [18, 22]	300 mg PO BID	
Rifampin [18, 22]	300 mg PO BID	
Azithromycin [33]	10 mg/kg PO daily	
Metabolic agents	Finasteride [26]	1–5 mg PO daily	
Spironolactone (≥ 14 years old) [27, 29]	50–200 mg PO daily	
Oral contraceptive pills (≥ 14 years old) [30]	1 pill PO daily	
Metformin (≥ 10 years old) [32]	Start at 500 mg PO daily, increase to max dose of 1000 mg PO BID	
Retinoids	Isotretinoin (≥ 12 years old) [36, 115]	0.5–1.0 mg/kg daily	
Biologics	Adalimumaba [12, 41]	FDA-approved for HS ≥ 12 years and for polyarticular JIA and uveitis ≥ 2 years

 < 60 kg: 80 mg SC day 1, 40 mg SC day 8, and then 40 mg SC every 2 weeks

 ≥ 60 kg: 160 mg SC day 1, 80 mg SC day 15, and then 40 mg SC weekly OR 80 mg SC every 2 weeks

	
Infliximab [40, 41]	5–10 mg/kg IV every at weeks 0, 2, 6, and then every 4–8 weeks	
Secukinumab [39]	FDA-approved for PsA ≥ 2 years

 < 50 kg: 75 mg SC weeks 0, 1, 2, 3, 4, and then every 4 weeks thereafter

 ≥ 50 kg: 150 mg SC weeks 0, 1, 2, 3, 4, and then every 4 weeks thereafter

	
Ustekinumab [42, 116]	FDA-approved for PsO and PsA ≥ 6 years

 < 60 kg: 0.75 mg/kg/dose SC weeks 0, 4, and then every 12 weeks thereafter

 ≥ 60–100 kg: 45 mg SC weeks 0, 4, and then every 12 weeks thereafter

 ≥ 100 kg: 90 mg SC weeks 0, 4, and then every 12 weeks thereafter

	
Anakinra [41]	FDA-approved for IL-1 receptor antagonist deficiency

100 mg SC daily

	
Small molecule inhibitors	Apremilastb [44]	20–50 kg: 10 mg PO QAM × 1 day, then 10 mg BID × 1 day, then 10 mg QAM and 20 mg QPM × 1 day, and then 20 mg BID

 ≥ 50 kg: 10 mg PO QAM × 1 day, then 10 mg BID × 1 day, then 10 mg QAM and 20 mg QPM × 1 day, then 20 mg PO BID × 1 day, then 20 mg QAM and 30 mg QPM × 1 day, and then 30 mg PO BID

	
Upadacitinibc (≥ 12 years old) [117]	FDA-approved for AD ≥ 12 years

 ≥ 40 kg: 15 mg PO daily, and increase to 30 mg PO daily if inadequate response

	
AD, atopic dermatitis; BID, twice daily; FDA, Food and Drug Administration; HS, hidradenitis suppurativa; IL, interleukin; IV, intravenous; JIA, juvenile idiopathic arthritis; PO, by mouth; PsA; psoriatic arthritis; PsO, psoriasis; QAM, once a day in the morning; QPM, once a day in the evening; SC, subcutaneously

aFDA approved for pediatric hidradenitis suppurativa

bSuggested dosing based on pediatric psoriasis literature

cSuggested dosing based on pediatric atopic dermatitis literature

Approach to pediatric dosing can be challenging and has historically been determined by using one of the following methods: (1) age-based categories, (2) weight-based dosing, (3) use of body surface area, and (4) an allometric scaling method where physiological function is related to body size [14]. The Pediatric Pharmacy Advocacy group recommends that weight-based dosing be utilized in patients under the age of 18 years who are less than 40 kg. Weight-based dosing should also be used in patients ≥ 40 kg, unless standard recommend adult dosing is surpassed [15]. Over 70% of pediatric patients with HS are 15–17 years of age [8], and thus are likely to require adult dosing for many medications. Of note, there is rising incidence of childhood obesity that can further complicate pediatric medication dosing, as it has been postulated that obese individuals may have decreased hepatic clearance and larger volume of distribution for lipophilic medications. Collaboration with a clinical pharmacist and pharmacokinetic analysis may be considered for overweight children to ensure safe and therapeutic dosing [15].

Topical Agents

Topical treatments may be considered first-line in milder disease states. Antiseptic washes such as chlorhexidine or benzoyl peroxide can be recommended for use in affected areas to help decrease bacterial load [12, 16]. Clindamycin 1% is the topical antibiotic of choice and can be used once to twice daily to active areas [17]. Resorcinol, a compounded topical keratolytic agent, may also be utilized as spot treatment twice daily to active lesions in pediatric patients with HS on the basis of promising efficacy in adults [18, 19].

Systemic Antibiotics

Systemic antibiotics may be utilized to address acute flares or as a bridge to more sustainable long-term therapeutics across all Hurley stages. Limited literature suggests that response rate to systemic antibiotics among pediatric patients is high [20]. Tetracyclines, such as doxycycline, can be utilized in patients over 8 years of age. They are generally not recommended in children under 8 years due to concerns for dental staining; however, more recent studies suggest that this age limit should be reconsidered if there may be substantial benefit to doxycycline use [21]. The combination of oral clindamycin and rifampin has been shown to be clinically effective in treating HS in pediatric populations [22]. Other systemic antibiotics that can be considered include trimethoprim-sulfamethoxazole, azithromycin, erythromycin, and metronidazole. Dapsone has been shown to improve disease in 9 out of 24 adults with HS, hypothetically due to its anti-inflammatory effects, but data on its use in pediatric patients with HS are limited [23]. Similarly, ertapenem, an intravenous beta-lactam antibiotic, has been efficacious as rescue treatment of adult HS, with little data on pediatric patients’ response [24].

Hormonal, Metabolic, and Supplement Therapies

Hormones likely play a role in HS pathogenesis, given onset of HS commonly occurs after puberty and for women; HS symptoms often flare with menses [25]. Modulating hormonal factors in adolescent patients, especially those undergoing puberty, can be helpful in managing HS symptoms across all severity levels. Finasteride, a 5-alpha reductase inhibitor, has been shown to reduce the frequency and severity of HS flares in female children in a few cases [26]. It is generally recommended to avoid finasteride use in males until after puberty. For post-menarche females over the age of 14 years, a combined oral contraceptive pill (OCP) or spironolactone may be used [27–30]. Pediatric female patients of childbearing age who are sexually active should undergo contraceptive counseling and adjunctive OCP if on finasteride or spironolactone, as these agents should be avoided during pregnancy. Metformin can be considered in pediatric patients with HS with milder disease or as an adjunct agent, particularly in patients with concomitant metabolic conditions such as obesity, type II diabetes mellitus, or insulin resistance. Several studies report improvement of pediatric HS on metformin, and a systemic review found metformin use to be relatively safe for managing obesity in children [20, 31, 32]. Additionally, oral zinc supplementation (90 mg/day) can be a useful and safe adjunctive therapy [33]. Low-dose copper should be co-administered, as zinc may deplete copper stores [34].

Retinoids

Consistent data suggesting efficacy of retinoids for HS is lacking; thus, they are only recommended as second- or third-line agents to consider for HS. Oral retinoids are best considered in patients with HS who have widespread comedones, a scarring folliculitis phenotype [35], or concomitant nodulocystic acne. Although the efficacy of isotretinoin has been inconsistent, younger age has been found to be associated with an improved response to isotretinoin [1, 36]. Two case reports suggest improvement of HS with acitretin use in adolescent boys with HS [37, 38].

Biologics

Adalimumab, a tumor necrosis factor (TNF) alpha inhibitor, is currently the only Food and Drug Administration (FDA)-approved biologic for pediatric HS in patients 12 years and older with moderate-to-severe disease. Secukinumab is an IL-17 inhibitor currently FDA-approved for treatment of moderate-to-severe HS in adults; however, it is approved for pediatric psoriatic arthritis down to the age of 2 years of age. Thus, it is reasonable to discuss secukinumab as a first- or second-line off-label treatment for pediatric HS on the basis of efficacy in adult clinical trials [39]. Dosing is weight dependent and typically lower than standard adult dosing. Infliximab, an intravenous TNF-alpha inhibitor, can be considered for severe or recalcitrant disease and is currently approved for treatment of Crohn’s disease and ulcerative colitis in patients aged 6 years and older. Several case studies demonstrate complete resolution or improvement of HS symptoms in adolescent patients while on infliximab therapy [40, 41]. A case series of 12 pediatric patients studied the efficacy of adalimumab, infliximab, and anakinra (an IL-1 antagonist) in treating HS. Results showed that 6 out of 7 patients who trialed infliximab, 4 out of 7 who trialed adalimumab, and the single patient who trialed anakinra achieved HS clinical response (HiSCR) after at least 4 months of treatment [41]. Ustekinumab, an anti-IL-12/IL-23 monoclonal antibody, is also recommended as a second-line agent in the North American Management Guidelines for HS [16]. One study of biologic use in children found that two patients treated with ustekinumab achieved complete resolution of HS symptoms without relapse within less than 12 months of therapy [42]. Ustekinumab is approved down to the age of 6 years for pediatric psoriasis and psoriatic arthritis. Anakinra, currently FDA-approved for treatment of IL-1 receptor antagonist deficiency, achieved HiSCR in a 15-year-old patient who had previously failed adalimumab and infliximab [41]. Although data on anakinra use for HS specifically in pediatric patients are limited, IL-1 inhibition may be considered as an alternative to those who have failed TNF and IL-17 inhibition.

Small Molecule Inhibitors

Oral small molecule inhibitors may be considered, especially for children who are unable to tolerate biologic injections. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has been shown to improve HS abscess and nodule count in adults [43]. Although apremilast does not currently have an FDA indication for use in children, no new safety signals were identified when studied in pediatric patients with plaque psoriasis [44]. Upadacitinib, a Janus kinase (JAK) 1 inhibitor, is FDA-approved for atopic dermatitis in children down to the age of 12 years and phase 3 adult HS trials are currently underway [45, 46].

Procedures for HS

Surgical management of HS should be considered when patients present with HS flares or persistent HS lesions despite medical management. Surgical interventions can be implemented in conjunction with medical management, but patients’ age, tolerance for in-office procedures, and parental comfort should be considered. A systematic review of procedural treatments across 81 pediatric HS had showed favorable response. Reported procedures included as incision and drainage (I&D), deroofing, excisions, photodynamic therapy, botulinum toxin, laser treatments, hyperbaric oxygen, negative pressure wound therapy, and cryoinsufflation [47]. I&D can be performed to relieve acutely painful abscesses [18, 48]. Intralesional steroid injections have been found to be effective in treating acutely painful nodular lesions in patients with HS; strategies such as dilution with lidocaine 1% or application of topical lidocaine with distraction techniques should be implemented to help decrease anxiety regarding injections [12]. Surgical deroofing, excisions, and laser therapy have also been used for pediatric patients [18, 49].

HS in Pregnancy

HS disproportionately affects women of childbearing age [50, 51]. Thus, clinicians must be familiar with treatment options for HS that are considered compatible with pregnancy and breastfeeding. There appears to be considerable variability in HS disease activity during pregnancy. Although some patients may see improvement of their HS, most patients may experience unchanged or worsening disease activity during pregnancy and in the post-partum period [52, 53]. Furthermore, women with HS have been found to be at higher risk of adverse maternal, and pregnancy-related and neonatal outcomes, such as preterm birth or gestational hypertension, with HS being an independent risk factor for spontaneous abortion, gestational diabetes and cesarean section [54]. Women with HS have also been found to have lower likelihood of live birth and higher odds of elective termination [55]. Therefore, it is crucial that patients maintain regular follow-up appointments with both their dermatologist and obstetrician throughout their pregnancy. Prospective, large-scale studies are needed to determine the impact of HS treatments on pregnancy outcomes.

The FDA previously categorized medications into A, B, C, D, and X, with A signifying adequate human studies showing no risk to fetus and X defined as positive evidence of human fetal risk [56]. The pregnancy letter categories were recently replaced by the Pregnancy and Lactation Labeling Rule in 2015, as many providers found the letter classification to be confusing and overly simplistic; however, they are included in this review for historical reference. HS medications that are considered compatible, can be used with caution, or contraindicated in pregnancy are listed in Table 2. Table 2 Agents used for hidradenitis suppurativa and their compatibility during pregnancy and breastfeeding

Guidancea	Treatment	Pregnancy	Lactation	
Compatible	Topical therapies	Chlorhexidine [57]

Benzoyl peroxide [58]

Clindamycin [58]

Metronidazole [58]

Erythromycin [58]

	Chlorhexidine [58]

Benzoyl peroxide [58]

Clindamycin [87]

Metronidazole

Erythromycin [58]

	
Systemic antibiotics	Clindamycin [118]

Cephalexin [58]

Cefdinir [118]

Amoxicillin/Clavulanate [119, 120]

Metronidazole [121]

	Clindamycin [87]

Cephalexin [122]

Cefdinir [123]

Amoxicillin/clavulanate [124]

Rifampin [125]

Ertapenem [126]

	
Hormonal, metabolic, and supplemental agents	Metformin [72, 127, 128]

Zinc [58]

	Spironolactone [129]

Metformin [91, 130]

Zinc [58]

	
Biologics	Certolizumab [131]	Certolizumab [132]

Adalimumab [93, 133]

Infliximab [134]

	
Use with caution	Systemic antibiotics	Rifampin [135]

Dapsone [65, 66]

Moxifloxacin [69, 136]

Ertapenem [70]

	Dapsone [137]

Moxifloxacin [138, 139]

Metronidazole [140]

	
Hormonal, metabolic, and supplemental agents		Oral contraceptive pills [58]	
Biologics	Adalimumab [73, 141]

Infliximab [73]

If unable to tolerate TNFi:

Secukinumab [80]

Ustekinumab [81, 82]

	If unable to tolerate TNFi

Secukinumab [96]

Ustekinumab [95]

	
Small molecule inhibitors	Apremilast [142]	Apremilast [142]	
Avoid use	Topical therapies	Resorcinol [143]	Resorcinol	
Systemic antibiotics	Tetracyclines [144]	Tetracyclines [145, 146]	
Metabolic	Spironolactone [147]

Oral contraceptive pills [58]

Finasteride [148]

	Finasteride [149]	
Small molecule inhibitors	Upadacitinib [150]	Upadacitinib [151]	
Other	Methotrexate [152]	Methotrexate [153]	
TNFi tumor necrosis factor inhibitors

aBenefits versus contraindications, risks, side effects, and inherent pregnancy risks should be weighed for each individual, and treatment decisions must be made on a case-by-case basis

Topical Agents

Antiseptic washes such as chlorhexidine wash and benzoyl peroxide wash are generally considered to be safe during pregnancy [57, 58]. Topical clindamycin 1% (Category B) can safely be recommended for pregnant women to treat active HS lesions [58].

Systemic Antibiotics

Systemic antibiotics for HS that are commonly prescribed by HS experts and generally considered safe to use during pregnancy include clindamycin (B), cephalexin (B), cefdinir (B), amoxicillin/clavulanate (B), and metronidazole (B) [59, 60]. Amoxicillin should be restricted to use in the second and third trimesters only due to potential risk of cleft lip and palate with exposure during the first trimester [61]. Although clindamycin is typically used in combination with rifampin, clindamycin monotherapy may have similar efficacy to combo therapy and thus is a reasonable treatment consideration [62].

Rifampin (C), dapsone (C), moxifloxacin (C), and ertapenem (B) should be used with caution during pregnancy. Rifampin should be considered on a case by case basis due to teratogenicity in animal studies and few reports of maternal and infant postnatal hemorrhage when used in the weeks preceding delivery and induction [63]. Tuberculosis consensus guidelines suggest that rifampin can be administered during pregnancy, thus clinicians may exercise use with caution when potential benefits outweigh risks [64]. Dapsone has not been associated with risk of congenital defects; however, cases of dose-related neonatal hemolysis [65] and hyperbilirubinemia [66] have been reported. While it is acceptable to use during pregnancy, it should be discontinued at least a month before birth to avoid kernicterus [66]. Moxifloxacin, a fluoroquinolone, has not been associated with a statistically significant increased risk of adverse pregnancy outcomes [67, 68]. Although there is limited human data, animal studies suggest increased risk of quinolone-induced arthropathy [69]. Intravenous ertapenem can be considered as rescue therapy for severe, recalcitrant HS [24]. Human safety data regarding ertapenem use during pregnancy are limited; however, animal studies suggest no developmental toxicity with fetal exposure of the drug. Mice exposed to drug in utero were found to have slight decreased fetal weight and decreased average number of ossified vertebrae [70]. Ertapenem may be used cautiously in scenarios where the clinical benefits outweigh risks.

Metabolic and Supplement Therapies

Metformin (B) can be utilized as adjunct therapy for HS in pregnant patients, especially in those with gestational diabetes. It is generally considered compatible with pregnancy, and two meta-analyses have not shown associated congenital abnormalities when taken during the first trimester [71, 72]. Zinc gluconate has also been shown to have therapeutic effects on HS, and is generally safe to use during pregnancy, although safety data is limited. Patients should be supplemented with low dose copper as excess zinc can deplete copper stores [34].

Biologics

Biologic safety data for treating of HS during pregnancy are limited, but many biologics have been tested in pregnant patients for other inflammatory conditions such as psoriasis and inflammatory bowel disease. Adalimumab (B) and infliximab (B) have not been associated with significant pregnancy or neonatal complications [73]. There is general consensus that adalimumab and infliximab are considered safe during the first two trimesters of pregnancy, and that, with the increased transfer of IgG antibodies across the placenta at the beginning of the third trimester, a discussion should be had regarding continuation versus discontinuation [74]. Risk of fetal drug exposure versus the potential for uncontrolled disease with medication discontinuation must be taken into consideration. If TNF-inhibition is continued through delivery, live vaccines should be avoided for at least the first 6 months of the newborn’s life [75]. Certolizumab (B), a pegylated anti-TNF-alpha agent, is considered safe to use throughout pregnancy due to limited transfer of the medication across the placenta [76]. HS-specific safety and efficacy data for certolizumab is lacking and is currently limited to a few case reports [77–79].

There is currently a lack of safety data to recommend use of IL-17 agents such as secukinumab (B) during pregnancy. The Novartis Global Safety Database did not identify increased risk of spontaneous abortion, congenital malformation, or safety signals among 238 exposures, though only 153 outcomes were known. Pregnancy outcome data, especially with drug exposure during the second and third trimesters, are further limited, as a vast majority of patients discontinued secukinumab during their first trimester [80]. Ustekinumab (B), an IL-12/23 antagonist, has limited data in pregnancy as well. Data from the Pregnancy Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) registry did not identify increased risk of spontaneous abortion or congenital malformations across 47 exposures. [81, 82]. Due to overall limited safety data, it is recommended that secukinumab and ustekinumab be considered only if a patient has failed or has a contraindication to TNF-alpha inhibition.

Small Molecule Inhibitors

There is limited human data on apremilast use in pregnancy. In animals, apremilast exposure during pregnancy has been associated with embryo-fetal death [83]. It is also recommended to avoid use of JAK inhibitors during pregnancy due to teratogenicity reported in animal studies [84].

Procedural Management

Major surgical procedures requiring sedation should be deferred until after delivery. However, in-office procedures including intralesional steroids and those that utilize local anesthesia are safe to perform during pregnancy. These procedures include local excision, incision and drainage, and de-roofing of sinus tracts. Local anesthesia is achieved with lidocaine (B) and is generally considered safe to use in pregnant individuals [85].

HS in Breastfeeding

Breastfeeding mothers with HS face unique challenges to both management of symptoms and safety of their child. Many patients experience postpartum flares, posing additional difficulties for these patients during a demanding time. Pain associated with HS, safety concerns regarding medications entering breastmilk, and concerns about their child coming into contact with HS can all impact a patient’s decision to breastfeed [86]. Clinicians should be familiar with the safety profile of HS therapies during lactation to minimize disruption of breastfeeding (Table 2).

Special Considerations for HS Treatment

Most medications safe to use in pregnancy are considered compatible during breastfeeding. Clindamycin is excreted into breast milk in small quantities and thus can be considered during breastfeeding; there is a small potential to disturb the gut microbiome in infants [87, 88]. Metronidazole can present in high concentrations in breast milk and should be discontinued 12–24 h prior to breastfeeding [89]. Rifampin is excreted into breast milk but has no adverse effects on infants. Therefore, it is safe to use in breastfeeding mothers with a similar caution with regards to its impact on the CYP-450 system [90]. Metformin is minimally excreted in breast milk and is generally safe to use in breastfeeding patients with HS [91]. Zinc does not enter breast milk; thus, it can be safely used [92].

Adalimumab and infliximab are both excreted in breast milk in negligible concentrations and are not well-absorbed through the gut; there have been no reported adverse effects on breastfeeding infants for either medication. Therefore, they are generally considered safe to prescribe during lactation [93]. Safety data on secukinumab and ustekinumab in breastfeeding are limited, but detection of these drugs in breast milk is expected to be low to minimal [94–96]. Apremilast and JAK inhibition should be avoided during lactation due to lack of human data [97].

HS in the Elderly

Geriatric HS is defined as the presence of active disease beyond the age of 65 years. The term “HS tarda” has been proposed and can be further subdivided in those with late onset and those with earlier onset and persistence into older age. The literature suggests a prevalence of 0.2% for late-onset HS and 0.8% for persistent HS in elderly individuals [98]. As in the adult population, elderly females are more commonly affected than elderly males. However, there was a higher proportion of males within the elderly HS population compared with the adult HS population (35.9% versus 22.8%) [98]. Overall, the female to male predominance is less in the older population compared with the adult population [99].

Literature suggests that HS can present more severely in elderly patients than their younger counterparts, and perhaps independent of overall disease duration [100–102]. Larger studies are needed to investigate for potential differences in clinical characteristics among those with late onset versus persistent HS. Elderly patients with HS are more likely to present with multiple comorbidities including hypertension, dyslipidemia, diabetes mellitus, cardiac disease, renal disease, hepatic abnormalities, obesity, and tobacco use [98, 103, 104]. Thus, considering comorbidities is an important aspect of selecting appropriate therapies for older patients with HS.

Special Considerations for HS Treatment

Treatment of HS in the elderly population should take into consideration the overall health of the patient, as well as comorbidities, medications, and goals of care.

The topical therapies discussed in above sections are also standard of care for elderly patients with milder HS or as adjunct therapies [100, 103]. Choosing an optimal systemic antibiotic agent is contingent upon careful medication review to ensure no medication interactions, given polypharmacy is common in elderly patients [105]. Rifampin, for example, can decrease bioavailability of drugs metabolized by the cytochrome P-450 system, such as warfarin, digoxin, amiodarone, statins, β-blockers, and sulfonylureas [106].

Although there is no documentation on the efficacy of finasteride on older patients with HS, finasteride has been shown to be safe in postmenopausal women (those without a menstrual cycle for 12 consecutive months) and older men, and it may be an appropriate adjuvant therapy for HS in elderly patients. Metformin is also an option for patients with metabolic comorbidities to achieve control of both insulin resistance and HS [107]. If prescribing spironolactone to an elderly female patient, potassium levels should be closely monitored, especially in the setting of renal impairment [108]. Other medications requiring dose adjustment for patients with renal impairment include rifampin, trimethoprim-sulfamethoxazole, cephalexin, ciprofloxacin, amoxicillin-clavulanate, dapsone, ertapenem, metformin, and spironolactone [109]. Tetracyclines, azithromycin, rifampin, metformin, and acitretin should be avoided in those with severe hepatic impairment [110]. According to the American Geriatrics Society 2023 Beers Criteria, trimethoprim-sulfamethoxazole, ciprofloxacin, spironolactone, systemic estrogens, non-steroidal anti-inflammatory drugs(NSAIDs), gabapentin, and opioids should be used with caution or avoided in the elderly [111].

Biologics including adalimumab, infliximab, secukinumab, and golimumab have been implemented as treatments for HS in the elderly [103]. TNF-inhibitors should be avoided in patients with a past medical history of class III or IV congestive heart failure [112]. There is currently limited evidence to guide clinicians on use of biologics in those with a history of malignancy. According to the joint American Academy of Dermatitis (AAD)-National Psoriasis Foundation (NPF) psoriasis guidelines, TNF-inhibitors are typically contraindicated in individuals with history of lymphoreticular malignancy but can be considered in patients with a history of solid tumor malignancy who have failed other therapies [112]. The AAD-NPF psoriasis guidelines do not list history of lymphoreticular or solid organ malignancy as relative or absolute contraindications to IL-17 inhibition [112]. A retrospective study of 42 psoriasis patients with a history of prior malignancy found no increased likelihood of malignancy recurrence with IL-17 inhibition [113]. Biologic use in patients with a history of malignancy should be discussed with the patient’s oncologist, when possible, prior to initiation.

In-office procedures can be safely utilized for elderly patients as in the aforementioned populations. Procedures requiring general anesthesia should be considered on a case-by-case basis and require a multidisciplinary approach and thorough pre-operative evaluation. Elderly individuals are at increased risk of perioperative complications due to reductions in physiologic reserve, functional status, and coexisting diseases [114]. Thus, benefits and risks should be weighed, and use of in-office procedures should be implemented when feasible. Post-operative use of NSAIDs and opioids should be limited whenever feasible [111].

Conclusion

HS is an oftentimes debilitating disease for patients across different stages of life. However, certain demographic groups present with distinct management challenges that require additional considerations, particularly around medication safety. More research is needed to guide optimization of HS care for pediatric, pregnant, breastfeeding, and elderly patients, as HS data specific to these populations remains limited.

Acknowledgements

Author Contribution

Claire S. Chung, Sarah E. Park, Jennifer L. Hsiao, and Katrina H. Lee contributed to drafting of the manuscript. Jennifer L. Hsiao and Katrina H. Lee contributed to concept and design.

Funding

No funding or sponsorship was received for this study or publication of this article.

Data Availability

Data sharing is not applicable to this article, as no datasets were generated or analyzed during the current study.

Declarations

Conflict of Interest

Jennifer L. Hsiao is on the Board of Directors for the Hidradenitis Suppurativa Foundation; has served as a consultant for AbbVie, Aclaris, Boehringer Ingelheim, Incyte, Novartis, and UCB; has acted as a speaker for AbbVie, Novartis, Sanofi Regeneron, and UCB; and has served as an investigator for Amgen, Boehringer Ingelheim, and Incyte. Claire S. Chung, Sarah E. Park, and Katrina H. Lee have nothing to disclose.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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References

1. Goldburg SR Strober BE Payette MJ Hidradenitis suppurativa J Am Acad Dermatol 2020 82 1045 1058 10.1016/j.jaad.2019.08.090 31604104
Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa. J Am Acad Dermatol. 2020;82:1045–58. 10.1016/j.jaad.2019.08.090.31604104 10.1016/j.jaad.2019.08.090
2. Garg A Kirby JS Lavian J Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States JAMA Dermatol 2017 153 760 764 10.1001/jamadermatol.2017.0201 28492923
Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017;153:760–4. 10.1001/jamadermatol.2017.0201.28492923 10.1001/jamadermatol.2017.0201
3. Delany E Gormley G Hughes R A cross-sectional epidemiological study of hidradenitis suppurativa in an Irish population (SHIP) J Eur Acad Dermatol Venereol 2018 32 467 473 10.1111/jdv.14686 29125658
Delany E, Gormley G, Hughes R, et al. A cross-sectional epidemiological study of hidradenitis suppurativa in an Irish population (SHIP). J Eur Acad Dermatol Venereol. 2018;32:467–73. 10.1111/jdv.14686.29125658 10.1111/jdv.14686
4. Hallock KK Mizerak MR Dempsey A Differences between children and adults with hidradenitis suppurativa JAMA Dermatol 2021 157 1095 10.1001/jamadermatol.2021.2865 34379074
Hallock KK, Mizerak MR, Dempsey A, et al. Differences between children and adults with hidradenitis suppurativa. JAMA Dermatol. 2021;157:1095. 10.1001/jamadermatol.2021.2865.34379074 10.1001/jamadermatol.2021.2865
5. Tiri H Jokelainen J Timonen M Substantially reduced life expectancy in patients with hidradenitis suppurativa: a Finnish nationwide registry study Br J Dermatol 2019 180 1543 1544 10.1111/bjd.17578 30597518
Tiri H, Jokelainen J, Timonen M, et al. Substantially reduced life expectancy in patients with hidradenitis suppurativa: a Finnish nationwide registry study. Br J Dermatol. 2019;180:1543–4. 10.1111/bjd.17578.30597518 10.1111/bjd.17578
6. Egeberg A GunnarH G Hansen PR Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa JAMA Dermatol 2016 152 429 434 10.1001/jamadermatol.2015.6264 26885728
Egeberg A, GunnarH G, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429–34. 10.1001/jamadermatol.2015.6264.26885728 10.1001/jamadermatol.2015.6264
7. Riis PT Søeby K Saunte DM Jemec GBE Patients with hidradenitis suppurativa carry a higher systemic inflammatory load than other dermatological patients Arch Dermatol Res 2015 307 885 889 10.1007/s00403-015-1596-5 26350517
Riis PT, Søeby K, Saunte DM, Jemec GBE. Patients with hidradenitis suppurativa carry a higher systemic inflammatory load than other dermatological patients. Arch Dermatol Res. 2015;307:885–9. 10.1007/s00403-015-1596-5.26350517 10.1007/s00403-015-1596-5
8. Garg A Wertenteil S Baltz R Prevalence estimates for hidradenitis suppurativa among children and adolescents in the United States: a gender- and age-adjusted population analysis J Investig Dermatol 2018 138 2152 2156 10.1016/j.jid.2018.04.001 29660301
Garg A, Wertenteil S, Baltz R, et al. Prevalence estimates for hidradenitis suppurativa among children and adolescents in the United States: a gender- and age-adjusted population analysis. J Investig Dermatol. 2018;138:2152–6. 10.1016/j.jid.2018.04.001.29660301 10.1016/j.jid.2018.04.001
9. Liy-Wong C Kim M Kirkorian AY Hidradenitis suppurativa in the pediatric population: an international, multicenter, retrospective, cross-sectional study of 481 pediatric patients JAMA Dermatol 2021 157 385 10.1001/jamadermatol.2020.5435 33625473
Liy-Wong C, Kim M, Kirkorian AY, et al. Hidradenitis suppurativa in the pediatric population: an international, multicenter, retrospective, cross-sectional study of 481 pediatric patients. JAMA Dermatol. 2021;157:385. 10.1001/jamadermatol.2020.5435.33625473 10.1001/jamadermatol.2020.5435
10. Saunte DM Boer J Stratigos A Diagnostic delay in hidradenitis suppurativa is a global problem Br J Dermatol 2015 173 1546 1549 10.1111/bjd.14038 26198191
Saunte DM, Boer J, Stratigos A, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015;173:1546–9. 10.1111/bjd.14038.26198191 10.1111/bjd.14038
11. Chang H-C Lin C-Y Guo Y-C Association between hidradenitis suppurativa and atopic diseases: a multi-center, propensity-score-matched cohort study Int J Med Sci 2024 21 299 305 10.7150/ijms.90086 38169580
Chang H-C, Lin C-Y, Guo Y-C, et al. Association between hidradenitis suppurativa and atopic diseases: a multi-center, propensity-score-matched cohort study. Int J Med Sci. 2024;21:299–305. 10.7150/ijms.90086.38169580 10.7150/ijms.90086
12. Cotton CH Chen SX Hussain SH Hidradenitis suppurativa in pediatric patients Pediatrics 2023 151 e2022061049 10.1542/peds.2022-061049 37102307
Cotton CH, Chen SX, Hussain SH, et al. Hidradenitis suppurativa in pediatric patients. Pediatrics. 2023;151: e2022061049. 10.1542/peds.2022-061049.37102307 10.1542/peds.2022-061049
13. Garg A Malviya N Strunk A Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations J Am Acad Dermatol 2022 86 1092 1101 10.1016/j.jaad.2021.01.059 33493574
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092–101. 10.1016/j.jaad.2021.01.059.33493574 10.1016/j.jaad.2021.01.059
14. Bartelink IH Rademaker CMA Schobben AFAM van den Anker JN Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations Clin Pharmacokinet 2006 45 1077 1097 10.2165/00003088-200645110-00003 17048973
Bartelink IH, Rademaker CMA, Schobben AFAM, van den Anker JN. Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations. Clin Pharmacokinet. 2006;45:1077–97. 10.2165/00003088-200645110-00003.17048973 10.2165/00003088-200645110-00003
15. Matson KL Horton ER Capino AC Advocacy Committee for the Pediatric Pharmacy Advocacy Group Medication dosage in overweight and obese children J Pediatr Pharmacol Ther JPPT Off J PPAG 2017 22 81 83 10.5863/1551-6776-22.1.81
Matson KL, Horton ER, Capino AC, Advocacy Committee for the Pediatric Pharmacy Advocacy Group. Medication dosage in overweight and obese children. J Pediatr Pharmacol Ther JPPT Off J PPAG. 2017;22:81–3. 10.5863/1551-6776-22.1.81.10.5863/1551-6776-22.1.81
16. Alikhan A Sayed C Alavi A North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations J Am Acad Dermatol 2019 81 91 101 10.1016/j.jaad.2019.02.068 30872149
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2019;81:91–101. 10.1016/j.jaad.2019.02.068.30872149 10.1016/j.jaad.2019.02.068
17. Clemmensen OJ Topical treatment of hidradenitis suppurativa with clindamycin Int J Dermatol 1983 22 325 328 10.1111/j.1365-4362.1983.tb02150.x 6347922
Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol. 1983;22:325–8. 10.1111/j.1365-4362.1983.tb02150.x.6347922 10.1111/j.1365-4362.1983.tb02150.x
18. Riis PT Saunte DM Sigsgaard V Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients Arch Dermatol Res 2020 312 715 724 10.1007/s00403-020-02053-6 32166376
Riis PT, Saunte DM, Sigsgaard V, et al. Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients. Arch Dermatol Res. 2020;312:715–24. 10.1007/s00403-020-02053-6.32166376 10.1007/s00403-020-02053-6
19. Katoulis A Efthymiou O Liakou A Resorcinol 10% as a promising therapeutic option for mild hidradenitis suppurativa: a prospective, randomized, open study Skin Appendage Disord 2023 9 438 443 10.1159/000531926 38058541
Katoulis A, Efthymiou O, Liakou A, et al. Resorcinol 10% as a promising therapeutic option for mild hidradenitis suppurativa: a prospective, randomized, open study. Skin Appendage Disord. 2023;9:438–43. 10.1159/000531926.38058541 10.1159/000531926
20. Masson R Ma E Parvathala N Efficacy of medical treatments for pediatric hidradenitis suppurativa: a systematic review Pediatr Dermatol 2023 40 775 788 10.1111/pde.15404 37525978
Masson R, Ma E, Parvathala N, et al. Efficacy of medical treatments for pediatric hidradenitis suppurativa: a systematic review. Pediatr Dermatol. 2023;40:775–88. 10.1111/pde.15404.37525978 10.1111/pde.15404
21. Pöyhönen H Nurmi M Peltola V Dental staining after doxycycline use in children J Antimicrob Chemother 2017 72 2887 2890 10.1093/jac/dkx245 29091225
Pöyhönen H, Nurmi M, Peltola V, et al. Dental staining after doxycycline use in children. J Antimicrob Chemother. 2017;72:2887–90. 10.1093/jac/dkx245.29091225 10.1093/jac/dkx245
22. Bettoli V Toni G Odorici G Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa–acne inversa in patients of paediatric age: a pilot prospective study Br J Dermatol 2021 185 216 217 10.1111/bjd.19867 33544882
Bettoli V, Toni G, Odorici G, et al. Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa–acne inversa in patients of paediatric age: a pilot prospective study. Br J Dermatol. 2021;185:216–7. 10.1111/bjd.19867.33544882 10.1111/bjd.19867
23. Yazdanyar S Boer J Ingvarsson G Dapsone therapy for hidradenitis suppurativa: a series of 24 patients Dermatology 2011 222 342 346 10.1159/000329023 21757878
Yazdanyar S, Boer J, Ingvarsson G, et al. Dapsone therapy for hidradenitis suppurativa: a series of 24 patients. Dermatology. 2011;222:342–6. 10.1159/000329023.21757878 10.1159/000329023
24. Nosrati A Ch’en PY Torpey ME Efficacy and durability of intravenous ertapenem therapy for recalcitrant hidradenitis suppurativa JAMA Dermatol 2024 160 312 318 10.1001/jamadermatol.2023.6201 38353987
Nosrati A, Ch’en PY, Torpey ME, et al. Efficacy and durability of intravenous ertapenem therapy for recalcitrant hidradenitis suppurativa. JAMA Dermatol. 2024;160:312–8. 10.1001/jamadermatol.2023.6201.38353987 10.1001/jamadermatol.2023.6201
25. Von Der Werth JM Williams HC The natural history of hidradenitis suppurativa J Eur Acad Dermatol Venereol 2000 14 389 392 10.1046/j.1468-3083.2000.00087.x 11305381
Von Der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389–92. 10.1046/j.1468-3083.2000.00087.x.11305381 10.1046/j.1468-3083.2000.00087.x
26. Randhawa HK Hamilton J Pope E Finasteride for the treatment of hidradenitis suppurativa in children and adolescents JAMA Dermatol 2013 149 732 735 10.1001/jamadermatol.2013.2874 23552442
Randhawa HK, Hamilton J, Pope E. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. JAMA Dermatol. 2013;149:732–5. 10.1001/jamadermatol.2013.2874.23552442 10.1001/jamadermatol.2013.2874
27. Horissian M Maczuga S Barbieri JS Zaenglein AL Trends in the prescribing pattern of spironolactone for acne and hidradenitis suppurativa in adolescents J Am Acad Dermatol 2022 87 684 686 10.1016/j.jaad.2021.12.005 34896127
Horissian M, Maczuga S, Barbieri JS, Zaenglein AL. Trends in the prescribing pattern of spironolactone for acne and hidradenitis suppurativa in adolescents. J Am Acad Dermatol. 2022;87:684–6. 10.1016/j.jaad.2021.12.005.34896127 10.1016/j.jaad.2021.12.005
28. Huang CY Shah SA Cochrane M Hidradenitis suppurativa disease control associated with type of hormonal contraceptive use Clin Exp Dermatol 2024 49 375 378 10.1093/ced/llad385 37940109
Huang CY, Shah SA, Cochrane M, et al. Hidradenitis suppurativa disease control associated with type of hormonal contraceptive use. Clin Exp Dermatol. 2024;49:375–8. 10.1093/ced/llad385.37940109 10.1093/ced/llad385
29. Masson R Park SE Shih T Spironolactone in hidradenitis suppurativa: a single-center Int J Womens Dermatol 2024 10 e135 10.1097/JW9.0000000000000135 38505270
Masson R, Park SE, Shih T, et al. Spironolactone in hidradenitis suppurativa: a single-center. Int J Womens Dermatol. 2024;10: e135. 10.1097/JW9.0000000000000135.38505270 10.1097/JW9.0000000000000135
30. Svoboda RM Nawaz N Zaenglein AL Hormonal treatment of acne and hidradenitis suppurativa in adolescent patients Dermatol Clin 2022 40 167 178 10.1016/j.det.2021.12.004 35366970
Svoboda RM, Nawaz N, Zaenglein AL. Hormonal treatment of acne and hidradenitis suppurativa in adolescent patients. Dermatol Clin. 2022;40:167–78. 10.1016/j.det.2021.12.004.35366970 10.1016/j.det.2021.12.004
31. Masarwa R Brunetti VC Aloe S Efficacy and safety of metformin for obesity: a systematic review Pediatrics 2021 147 e20201610 10.1542/peds.2020-1610 33608415
Masarwa R, Brunetti VC, Aloe S, et al. Efficacy and safety of metformin for obesity: a systematic review. Pediatrics. 2021;147: e20201610. 10.1542/peds.2020-1610.33608415 10.1542/peds.2020-1610
32. Moussa C Wadowski L Price H Metformin as adjunctive therapy for pediatric patients with hidradenitis suppurativa J Drugs Dermatol JDD 2020 19 1231 1234 10.36849/JDD.2020.5447 33346525
Moussa C, Wadowski L, Price H, et al. Metformin as adjunctive therapy for pediatric patients with hidradenitis suppurativa. J Drugs Dermatol JDD. 2020;19:1231–4. 10.36849/JDD.2020.5447.33346525 10.36849/JDD.2020.5447
33. Offidani A Molinelli E Sechi A Hidradenitis suppurativa in a prepubertal case series: a call for specific guidelines J Eur Acad Dermatol Venereol JEADV 2019 33 Suppl 6 28 31 10.1111/jdv.15827 31535767
Offidani A, Molinelli E, Sechi A, et al. Hidradenitis suppurativa in a prepubertal case series: a call for specific guidelines. J Eur Acad Dermatol Venereol JEADV. 2019;33(Suppl 6):28–31. 10.1111/jdv.15827.31535767 10.1111/jdv.15827
34. Duncan A Yacoubian C Watson N Morrison I The risk of copper deficiency in patients prescribed zinc supplements J Clin Pathol 2015 68 723 725 10.1136/jclinpath-2014-202837 26085547
Duncan A, Yacoubian C, Watson N, Morrison I. The risk of copper deficiency in patients prescribed zinc supplements. J Clin Pathol. 2015;68:723–5. 10.1136/jclinpath-2014-202837.26085547 10.1136/jclinpath-2014-202837
35. Bouwman K Aarts P Dudink K Drug survival of oral retinoids in hidradenitis suppurativa: a real-life cohort study Am J Clin Dermatol 2022 23 905 914 10.1007/s40257-022-00725-9 36070059
Bouwman K, Aarts P, Dudink K, et al. Drug survival of oral retinoids in hidradenitis suppurativa: a real-life cohort study. Am J Clin Dermatol. 2022;23:905–14. 10.1007/s40257-022-00725-9.36070059 10.1007/s40257-022-00725-9
36. Huang CM Kirchhof MG A new perspective on isotretinoin treatment of hidradenitis suppurativa: a retrospective chart review of patient outcomes Dermatol Basel Switz 2017 233 120 125 10.1159/000477207
Huang CM, Kirchhof MG. A new perspective on isotretinoin treatment of hidradenitis suppurativa: a retrospective chart review of patient outcomes. Dermatol Basel Switz. 2017;233:120–5. 10.1159/000477207.10.1159/000477207
37. Marzuillo P Caiazzo R Coppola C Polyclonal gammopathy in an adolescent affected by Dent disease 2 and hidradenitis suppurativa Int J Dermatol 2020 59 e201 e203 10.1111/ijd.14789 31971248
Marzuillo P, Caiazzo R, Coppola C, et al. Polyclonal gammopathy in an adolescent affected by Dent disease 2 and hidradenitis suppurativa. Int J Dermatol. 2020;59:e201–3. 10.1111/ijd.14789.31971248 10.1111/ijd.14789
38. Chen A-W Chen Z Bai X-M Successful treatment of early-onset hidradenitis suppurativa with acitretin in an infant with a novel mutation in PSENEN gene Indian J Dermatol Venereol Leprol 2022 88 445 10.25259/IJDVL_471_19 35146980
Chen A-W, Chen Z, Bai X-M, et al. Successful treatment of early-onset hidradenitis suppurativa with acitretin in an infant with a novel mutation in PSENEN gene. Indian J Dermatol Venereol Leprol. 2022;88:445. 10.25259/IJDVL_471_19.35146980 10.25259/IJDVL_471_19
39. Kimball AB Jemec GBE Alavi A Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials Lancet Lond Engl 2023 401 747 761 10.1016/S0140-6736(23)00022-3
Kimball AB, Jemec GBE, Alavi A, et al. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials. Lancet Lond Engl. 2023;401:747–61. 10.1016/S0140-6736(23)00022-3.10.1016/S0140-6736(23)00022-3
40. Adams DR Severe hidradenitis suppurativa treated with infliximab infusion Arch Dermatol 2003 139 1540 10.1001/archderm.139.12.1540 14676068
Adams DR. Severe hidradenitis suppurativa treated with infliximab infusion. Arch Dermatol. 2003;139:1540. 10.1001/archderm.139.12.1540.14676068 10.1001/archderm.139.12.1540
41. Fougerousse A-C Reguiai Z Roussel A Bécherel P-A Hidradenitis suppurativa management using tumor necrosis factor inhibitors in patients younger than 18 years: a series of 12 cases J Am Acad Dermatol 2020 83 199 201 10.1016/j.jaad.2020.02.071 32151626
Fougerousse A-C, Reguiai Z, Roussel A, Bécherel P-A. Hidradenitis suppurativa management using tumor necrosis factor inhibitors in patients younger than 18 years: a series of 12 cases. J Am Acad Dermatol. 2020;83:199–201. 10.1016/j.jaad.2020.02.071.32151626 10.1016/j.jaad.2020.02.071
42. Sachdeva M Kim P Mufti A Biologic use in pediatric patients with hidradenitis suppurativa: a systematic review J Cutan Med Surg 2022 26 176 180 10.1177/12034754211049711 34587768
Sachdeva M, Kim P, Mufti A, et al. Biologic use in pediatric patients with hidradenitis suppurativa: a systematic review. J Cutan Med Surg. 2022;26:176–80. 10.1177/12034754211049711.34587768 10.1177/12034754211049711
43. Vossen ARJV van Doorn MBA van der Zee HH Prens EP Apremilast for moderate hidradenitis suppurativa: Results of a randomized controlled trial J Am Acad Dermatol 2019 80 80 88 10.1016/j.jaad.2018.06.046 30482392
Vossen ARJV, van Doorn MBA, van der Zee HH, Prens EP. Apremilast for moderate hidradenitis suppurativa: Results of a randomized controlled trial. J Am Acad Dermatol. 2019;80:80–8. 10.1016/j.jaad.2018.06.046.30482392 10.1016/j.jaad.2018.06.046
44. Fiorillo L Becker E de Lucas R Efficacy and safety of apremilast in pediatric patients with moderate-to-severe plaque psoriasis: 16-week results from SPROUT, a randomized controlled trial J Am Acad Dermatol 2024 90 1232 1239 10.1016/j.jaad.2023.11.068 38266683
Fiorillo L, Becker E, de Lucas R, et al. Efficacy and safety of apremilast in pediatric patients with moderate-to-severe plaque psoriasis: 16-week results from SPROUT, a randomized controlled trial. J Am Acad Dermatol. 2024;90:1232–9. 10.1016/j.jaad.2023.11.068.38266683 10.1016/j.jaad.2023.11.068
45. AbbVie. A phase 2, multicenter, randomized, placebo-controlled, double-blind study to evaluate upadacitinib in adult subjects with moderate to severe hidradenitis suppurativa. clinicaltrials.gov (2023).
46. AbbVie. A phase 3, randomized, placebo-controlled, double-blind study to evaluate efficacy and safety of upadacitinib in adult and adolescent subjects with moderate to severe hidradenitis suppurativa who have failed anti-TNF therapy. clinicaltrials.gov (2024).
47. Masson R Parvathala N Ma E Efficacy of procedural treatments for pediatric hidradenitis suppurativa: a systematic review Pediatr Dermatol 2023 40 595 605 10.1111/pde.15331 37092729
Masson R, Parvathala N, Ma E, et al. Efficacy of procedural treatments for pediatric hidradenitis suppurativa: a systematic review. Pediatr Dermatol. 2023;40:595–605. 10.1111/pde.15331.37092729 10.1111/pde.15331
48. Lambert RA Stein SL Pediatric hidradenitis suppurativa: describing care patterns in the emergency department Pediatr Dermatol 2023 40 434 439 10.1111/pde.15231 36856161
Lambert RA, Stein SL. Pediatric hidradenitis suppurativa: describing care patterns in the emergency department. Pediatr Dermatol. 2023;40:434–9. 10.1111/pde.15231.36856161 10.1111/pde.15231
49. Leszczynska M Diaz LZ Peña-Robichaux V Surgical deroofing in pediatric patients with hidradenitis suppurativa Pediatr Dermatol 2022 39 502 505 10.1111/pde.14955 35178762
Leszczynska M, Diaz LZ, Peña-Robichaux V. Surgical deroofing in pediatric patients with hidradenitis suppurativa. Pediatr Dermatol. 2022;39:502–5. 10.1111/pde.14955.35178762 10.1111/pde.14955
50. Cosmatos I Matcho A Weinstein R Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States J Am Acad Dermatol 2013 68 412 419 10.1016/j.jaad.2012.07.027 22921795
Cosmatos I, Matcho A, Weinstein R, et al. Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States. J Am Acad Dermatol. 2013;68:412–9. 10.1016/j.jaad.2012.07.027.22921795 10.1016/j.jaad.2012.07.027
51. Garg A Lavian J Lin G Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis J Am Acad Dermatol 2017 77 118 122 10.1016/j.jaad.2017.02.005 28285782
Garg A, Lavian J, Lin G, et al. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;77:118–22. 10.1016/j.jaad.2017.02.005.28285782 10.1016/j.jaad.2017.02.005
52. Lyons AB Peacock A McKenzie SA Evaluation of hidradenitis suppurativa disease course during pregnancy and postpartum JAMA Dermatol 2020 156 681 685 10.1001/jamadermatol.2020.0777 32347884
Lyons AB, Peacock A, McKenzie SA, et al. Evaluation of hidradenitis suppurativa disease course during pregnancy and postpartum. JAMA Dermatol. 2020;156:681–5. 10.1001/jamadermatol.2020.0777.32347884 10.1001/jamadermatol.2020.0777
53. Seivright JR Villa NM Grogan T Impact of pregnancy on hidradenitis suppurativa disease course: a systematic review and meta-analysis Dermatol Basel Switz 2022 238 260 266 10.1159/000517283
Seivright JR, Villa NM, Grogan T, et al. Impact of pregnancy on hidradenitis suppurativa disease course: a systematic review and meta-analysis. Dermatol Basel Switz. 2022;238:260–6. 10.1159/000517283.10.1159/000517283
54. Fitzpatrick L Hsiao J Tannenbaum R Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa J Am Acad Dermatol 2022 86 46 54 10.1016/j.jaad.2021.06.023 34126093
Fitzpatrick L, Hsiao J, Tannenbaum R, et al. Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86:46–54. 10.1016/j.jaad.2021.06.023.34126093 10.1016/j.jaad.2021.06.023
55. Sakya SM Hallan DR Maczuga SA Kirby JS Outcomes of pregnancy and childbirth in women with hidradenitis suppurativa J Am Acad Dermatol 2022 86 61 67 10.1016/j.jaad.2021.05.059 34153386
Sakya SM, Hallan DR, Maczuga SA, Kirby JS. Outcomes of pregnancy and childbirth in women with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86:61–7. 10.1016/j.jaad.2021.05.059.34153386 10.1016/j.jaad.2021.05.059
56. Sachdeva P Patel BG Patel BK Drug use in pregnancy; a point to ponder! Indian J Pharm Sci 2009 71 1 7 10.4103/0250-474X.51941 20177448
Sachdeva P, Patel BG, Patel BK. Drug use in pregnancy; a point to ponder! Indian J Pharm Sci. 2009;71:1–7. 10.4103/0250-474X.51941.20177448 10.4103/0250-474X.51941
57. McClure EM Goldenberg RL Brandes N The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings Int J Gynaecol Obstet 2007 97 89 94 10.1016/j.ijgo.2007.01.014 17399714
McClure EM, Goldenberg RL, Brandes N, et al. The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings. Int J Gynaecol Obstet. 2007;97:89–94. 10.1016/j.ijgo.2007.01.014.17399714 10.1016/j.ijgo.2007.01.014
58. Kong YL Tey HL Treatment of acne vulgaris during pregnancy and lactation Drugs 2013 73 779 787 10.1007/s40265-013-0060-0 23657872
Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73:779–87. 10.1007/s40265-013-0060-0.23657872 10.1007/s40265-013-0060-0
59. Chien AL Qi J Rainer B Treatment of acne in pregnancy J Am Board Fam Med 2016 29 254 262 10.3122/jabfm.2016.02.150165 26957383
Chien AL, Qi J, Rainer B, et al. Treatment of acne in pregnancy. J Am Board Fam Med. 2016;29:254–62. 10.3122/jabfm.2016.02.150165.26957383 10.3122/jabfm.2016.02.150165
60. Collier EK Seivright JR Shi VY Hsiao JL Pregnancy and breastfeeding in hidradenitis suppurativa: a review of medication safety Dermatol Ther 2021 34 e14674 10.1111/dth.14674 33320387
Collier EK, Seivright JR, Shi VY, Hsiao JL. Pregnancy and breastfeeding in hidradenitis suppurativa: a review of medication safety. Dermatol Ther. 2021;34: e14674. 10.1111/dth.14674.33320387 10.1111/dth.14674
61. Lin KJ Mitchell AA Yau W-P Maternal exposure to amoxicillin and the risk of oral clefts Epidemiol Camb Mass 2012 23 699 705 10.1097/EDE.0b013e318258cb05
Lin KJ, Mitchell AA, Yau W-P, et al. Maternal exposure to amoxicillin and the risk of oral clefts. Epidemiol Camb Mass. 2012;23:699–705. 10.1097/EDE.0b013e318258cb05.10.1097/EDE.0b013e318258cb05
62. Caposiena Caro RD Cannizzaro MV Botti E Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasound observations J Am Acad Dermatol 2019 80 1314 1321 10.1016/j.jaad.2018.11.035 30502416
Caposiena Caro RD, Cannizzaro MV, Botti E, et al. Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasound observations. J Am Acad Dermatol. 2019;80:1314–21. 10.1016/j.jaad.2018.11.035.30502416 10.1016/j.jaad.2018.11.035
63. Sanofi. rifadin.pdf. In: RIFADIN® Rx Rifampin Capsul. USP RIFADIN® IV Rifampin Inject. USP. https://products.sanofi.us/rifadin/rifadin.pdf (2024). Accessed 7 July 2024.
64. API Consensus Expert Committee API TB consensus guidelines 2006: management of pulmonary tuberculosis, extra-pulmonary tuberculosis and tuberculosis in special situations J Assoc Physicians India 2006 54 219 234 16800350
API Consensus Expert Committee. API TB consensus guidelines 2006: management of pulmonary tuberculosis, extra-pulmonary tuberculosis and tuberculosis in special situations. J Assoc Physicians India. 2006;54:219–34.16800350
65. Hocking DR Neonatal haemolytic disease due to dapsone Med J Aust 1968 1 1130 1131 10.5694/j.1326-5377.1968.tb29209.x 4969972
Hocking DR. Neonatal haemolytic disease due to dapsone. Med J Aust. 1968;1:1130–1. 10.5694/j.1326-5377.1968.tb29209.x.4969972 10.5694/j.1326-5377.1968.tb29209.x
66. Thornton YS Bowe ET Neonatal hyperbilirubinemia after treatment of maternal leprosy South Med J 1989 82 668 10.1097/00007611-198905000-00037 2717998
Thornton YS, Bowe ET. Neonatal hyperbilirubinemia after treatment of maternal leprosy. South Med J. 1989;82:668. 10.1097/00007611-198905000-00037.2717998 10.1097/00007611-198905000-00037
67. Ziv A Masarwa R Perlman A Pregnancy outcomes following exposure to quinolone antibiotics—a systematic-review and meta-analysis Pharm Res 2018 35 109 10.1007/s11095-018-2383-8 29582196
Ziv A, Masarwa R, Perlman A, et al. Pregnancy outcomes following exposure to quinolone antibiotics—a systematic-review and meta-analysis. Pharm Res. 2018;35:109. 10.1007/s11095-018-2383-8.29582196 10.1007/s11095-018-2383-8
68. Acar S Keskin-Arslan E Erol-Coskun H Pregnancy outcomes following quinolone and fluoroquinolone exposure during pregnancy: a systematic review and meta-analysis Reprod Toxicol Elmsford N 2019 85 65 74 10.1016/j.reprotox.2019.02.002
Acar S, Keskin-Arslan E, Erol-Coskun H, et al. Pregnancy outcomes following quinolone and fluoroquinolone exposure during pregnancy: a systematic review and meta-analysis. Reprod Toxicol Elmsford N. 2019;85:65–74. 10.1016/j.reprotox.2019.02.002.10.1016/j.reprotox.2019.02.002
69. Burkhardt JE Hill MA Carlton WW Kesterson JW Histologic and histochemical changes in articular cartilages of immature beagle dogs dosed with difloxacin, a fluoroquinolone Vet Pathol 1990 27 162 170 10.1177/030098589002700303 2353417
Burkhardt JE, Hill MA, Carlton WW, Kesterson JW. Histologic and histochemical changes in articular cartilages of immature beagle dogs dosed with difloxacin, a fluoroquinolone. Vet Pathol. 1990;27:162–70. 10.1177/030098589002700303.2353417 10.1177/030098589002700303
70. Merck. invanz_pi.pdf. In: INVANZ® Ertapenem Inject. https://www.merck.com/product/usa/pi_circulars/i/invanz/invanz_pi.pdf (2022). Accessed 7 July 2024.
71. Gutzin SJ Kozer E Magee LA The safety of oral hypoglycemic agents in the first trimester of pregnancy: a meta-analysis Can J Clin Pharmacol 2003 10 179 183 14712322
Gutzin SJ, Kozer E, Magee LA, et al. The safety of oral hypoglycemic agents in the first trimester of pregnancy: a meta-analysis. Can J Clin Pharmacol. 2003;10:179–83.14712322
72. Gilbert C Valois M Koren G Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis Fertil Steril 2006 86 658 663 10.1016/j.fertnstert.2006.02.098 16879826
Gilbert C, Valois M, Koren G. Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis. Fertil Steril. 2006;86:658–63. 10.1016/j.fertnstert.2006.02.098.16879826 10.1016/j.fertnstert.2006.02.098
73. Wang H Hu Y Chen F Shen M Comparative safety of infliximab and adalimumab on pregnancy outcomes of women with inflammatory bowel diseases: a systematic review and meta-analysis BMC Pregnancy Childbirth 2022 22 854 10.1186/s12884-022-05191-z 36402978
Wang H, Hu Y, Chen F, Shen M. Comparative safety of infliximab and adalimumab on pregnancy outcomes of women with inflammatory bowel diseases: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022;22:854. 10.1186/s12884-022-05191-z.36402978 10.1186/s12884-022-05191-z
74. Elmets CA Korman NJ Prater EF Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures J Am Acad Dermatol 2021 84 432 470 10.1016/j.jaad.2020.07.087 32738429
Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84:432–70. 10.1016/j.jaad.2020.07.087.32738429 10.1016/j.jaad.2020.07.087
75. Nguyen GC Seow CH Maxwell C The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy Gastroenterology 2016 150 734 757.e1 10.1053/j.gastro.2015.12.003 26688268
Nguyen GC, Seow CH, Maxwell C, et al. The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology. 2016;150:734-757.e1. 10.1053/j.gastro.2015.12.003.26688268 10.1053/j.gastro.2015.12.003
76. Owczarek W Walecka I Lesiak A The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines Adv Dermatol Allergol 2020 37 821 830 10.5114/ada.2020.102089
Owczarek W, Walecka I, Lesiak A, et al. The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines. Adv Dermatol Allergol. 2020;37:821–30. 10.5114/ada.2020.102089.10.5114/ada.2020.102089
77. Holm JG Jørgensen A-HR Yao Y Thomsen SF Certolizumab pegol for hidradenitis suppurativa: case report and literature review Dermatol Ther 2020 33 e14494 10.1111/dth.14494 33135826
Holm JG, Jørgensen A-HR, Yao Y, Thomsen SF. Certolizumab pegol for hidradenitis suppurativa: case report and literature review. Dermatol Ther. 2020;33: e14494. 10.1111/dth.14494.33135826 10.1111/dth.14494
78. Repetto F Burzi L Ramondetta A Certolizumab pegol and its role in pregnancy-age hidradenitis suppurativa Int J Dermatol 2022 10.1111/ijd.15742 34480753
Repetto F, Burzi L, Ramondetta A, et al. Certolizumab pegol and its role in pregnancy-age hidradenitis suppurativa. Int J Dermatol. 2022. 10.1111/ijd.15742.34480753 10.1111/ijd.15742
79. Wohlmuth-Wieser I Alhusayen R Treatment of hidradenitis suppurativa with certolizumab pegol during pregnancy Int J Dermatol 2021 10.1111/ijd.15286 33247833
Wohlmuth-Wieser I, Alhusayen R. Treatment of hidradenitis suppurativa with certolizumab pegol during pregnancy. Int J Dermatol. 2021. 10.1111/ijd.15286.33247833 10.1111/ijd.15286
80. Warren RB Reich K Langley RG Secukinumab in pregnancy: outcomes in psoriasis, psoriatic arthritis and ankylosing spondylitis from the global safety database Br J Dermatol 2018 179 1205 1207 10.1111/bjd.16901 29927479
Warren RB, Reich K, Langley RG, et al. Secukinumab in pregnancy: outcomes in psoriasis, psoriatic arthritis and ankylosing spondylitis from the global safety database. Br J Dermatol. 2018;179:1205–7. 10.1111/bjd.16901.29927479 10.1111/bjd.16901
81. Chugh R Long MD Jiang Y Maternal and neonatal outcomes in vedolizumab- and ustekinumab-exposed pregnancies: results from the PIANO registry Off J Am Coll Gastroenterol ACG 2024 119 468 10.14309/ajg.0000000000002553
Chugh R, Long MD, Jiang Y, et al. Maternal and neonatal outcomes in vedolizumab- and ustekinumab-exposed pregnancies: results from the PIANO registry. Off J Am Coll Gastroenterol ACG. 2024;119:468. 10.14309/ajg.0000000000002553.10.14309/ajg.0000000000002553
82. Meyer A Miranda S Drouin J Safety of vedolizumab and ustekinumab compared with anti-tnf in pregnant women with inflammatory bowel disease Clin Gastroenterol Hepatol 2024 S1542–3565 24 00010 17 10.1016/j.cgh.2023.12.029
Meyer A, Miranda S, Drouin J, et al. Safety of vedolizumab and ustekinumab compared with anti-tnf in pregnant women with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2024;S1542–3565(24):00010–7. 10.1016/j.cgh.2023.12.029.10.1016/j.cgh.2023.12.029
83. US Food and Drug Administration. 205437s006lbl.pdf. In: OTEZLA® Apremilast Tablets Oral Use. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/205437s006lbl.pdf (2017). Accessed 30 June 2024.
84. Akiyama S Steinberg JM Kobayashi M Pregnancy and medications for inflammatory bowel disease: an updated narrative review World J Clin Cases 2023 11 1730 1740 10.12998/wjcc.v11.i8.1730 36969991
Akiyama S, Steinberg JM, Kobayashi M, et al. Pregnancy and medications for inflammatory bowel disease: an updated narrative review. World J Clin Cases. 2023;11:1730–40. 10.12998/wjcc.v11.i8.1730.36969991 10.12998/wjcc.v11.i8.1730
85. U.S. Food and Drug Administration. 006488s074lbl.pdf. In: Xylocaine Lidocaine HCl Inject. USP. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/006488s074lbl.pdf (2010). Accessed 30 June 2024.
86. Westerkam L Masson R Hsiao J Sayed CJ A survey-based study evaluating breastfeeding decisions and their impact on management in patients with hidradenitis suppurativa J Am Acad Dermatol 2024 90 1023 1025 10.1016/j.jaad.2023.12.043 38185255
Westerkam L, Masson R, Hsiao J, Sayed CJ. A survey-based study evaluating breastfeeding decisions and their impact on management in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2024;90:1023–5. 10.1016/j.jaad.2023.12.043.38185255 10.1016/j.jaad.2023.12.043
87. Stéen B Rane A Clindamycin passage into human milk Br J Clin Pharmacol 1982 13 661 664 10.1111/j.1365-2125.1982.tb01433.x 7082533
Stéen B, Rane A. Clindamycin passage into human milk. Br J Clin Pharmacol. 1982;13:661–4.7082533 10.1111/j.1365-2125.1982.tb01433.x
88. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Clindamycin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501208/. Accessed 15 Feb 2021.
89. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Metronidazole. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501315/. Accessed 15 Sep 2023.
90. Chellappan Dermatologic management of hidradenitis suppurativa and impact on pregnancy and breastfeeding Cutis 2022 10.12788/cutis.0480 35659142
Chellappan. Dermatologic management of hidradenitis suppurativa and impact on pregnancy and breastfeeding. Cutis. 2022. 10.12788/cutis.0480.35659142 10.12788/cutis.0480
91. Hale TW Kristensen JH Hackett LP Transfer of metformin into human milk Diabetologia 2002 45 1509 1514 10.1007/s00125-002-0939-x 12436333
Hale TW, Kristensen JH, Hackett LP, et al. Transfer of metformin into human milk. Diabetologia. 2002;45:1509–14. 10.1007/s00125-002-0939-x.12436333 10.1007/s00125-002-0939-x
92. Perng P Zampella JG Okoye GA Management of hidradenitis suppurativa in pregnancy J Am Acad Dermatol 2017 76 979 989 10.1016/j.jaad.2016.10.032 28040373
Perng P, Zampella JG, Okoye GA. Management of hidradenitis suppurativa in pregnancy. J Am Acad Dermatol. 2017;76:979–89. 10.1016/j.jaad.2016.10.032.28040373 10.1016/j.jaad.2016.10.032
93. Fritzsche J Pilch A Mury D Infliximab and adalimumab use during breastfeeding J Clin Gastroenterol 2012 46 718 10.1097/MCG.0b013e31825f2807 22858514
Fritzsche J, Pilch A, Mury D, et al. Infliximab and adalimumab use during breastfeeding. J Clin Gastroenterol. 2012;46:718. 10.1097/MCG.0b013e31825f2807.22858514 10.1097/MCG.0b013e31825f2807
94. Balakirski G Gerdes S Beissert S Therapy of psoriasis during pregnancy and breast-feeding J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG 2022 20 653 683 10.1111/ddg.14789
Balakirski G, Gerdes S, Beissert S, et al. Therapy of psoriasis during pregnancy and breast-feeding. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG. 2022;20:653–83. 10.1111/ddg.14789.10.1111/ddg.14789
95. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Ustekinumab. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500594/. Accessed 15 July 2024.
96. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Secukinumab. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500738/. Accessed 15 Nov 2023.
97. Ibarra Barrueta O García Martín E López Sánchez P Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases Farm Hosp 2023 47 39 49 10.1016/j.farma.2022.12.005 36710223
Ibarra Barrueta O, García Martín E, López Sánchez P, et al. Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases. Farm Hosp. 2023;47:39–49. 10.1016/j.farma.2022.12.005.36710223 10.1016/j.farma.2022.12.005
98. Van Der Weijden DAY Koerts NDK Van Munster BC Hidradenitis suppurativa tarda: defining an understudied elderly population Br J Dermatol 2023 190 105 113 10.1093/bjd/ljad317 37665963
Van Der Weijden DAY, Koerts NDK, Van Munster BC, et al. Hidradenitis suppurativa tarda: defining an understudied elderly population. Br J Dermatol. 2023;190:105–13. 10.1093/bjd/ljad317.37665963 10.1093/bjd/ljad317
99. White JM Del Marmol V Hidradenitis suppurativa in the elderly: new insights Br J Dermatol 2023 10.1093/bjd/ljad378 37789680
White JM, Del Marmol V. Hidradenitis suppurativa in the elderly: new insights. Br J Dermatol. 2023. 10.1093/bjd/ljad378.37789680 10.1093/bjd/ljad378
100. Antonelli F Ippoliti E Rosi E Clinical features and response to treatment in elderly subjects affected by hidradenitis suppurativa: a cohort study J Clin Med 2023 12 7754 10.3390/jcm12247754 38137823
Antonelli F, Ippoliti E, Rosi E, et al. Clinical features and response to treatment in elderly subjects affected by hidradenitis suppurativa: a cohort study. J Clin Med. 2023;12:7754. 10.3390/jcm12247754.38137823 10.3390/jcm12247754
101. Jiang SW Petty AJ Jacobs JL Association between age at symptom onset and disease severity in older patients with hidradenitis suppurativa Br J Dermatol 2023 188 555 576 10.1093/bjd/ljac121 36715616
Jiang SW, Petty AJ, Jacobs JL, et al. Association between age at symptom onset and disease severity in older patients with hidradenitis suppurativa. Br J Dermatol. 2023;188:555–76. 10.1093/bjd/ljac121.36715616 10.1093/bjd/ljac121
102. Nielsen VW Ring HC Holgersen N Thomsen SF Elderly male patients with hidradenitis suppurativa have more severe disease independent of disease duration Br J Dermatol 2024 190 292 293 10.1093/bjd/ljad411 37874834
Nielsen VW, Ring HC, Holgersen N, Thomsen SF. Elderly male patients with hidradenitis suppurativa have more severe disease independent of disease duration. Br J Dermatol. 2024;190:292–3. 10.1093/bjd/ljad411.37874834 10.1093/bjd/ljad411
103. Blum FR DeBarmore BM Sayed CJ Hidradenitis suppurativa in older adults JAMA Dermatol 2023 159 216 10.1001/jamadermatol.2022.5390 36515944
Blum FR, DeBarmore BM, Sayed CJ. Hidradenitis suppurativa in older adults. JAMA Dermatol. 2023;159:216. 10.1001/jamadermatol.2022.5390.36515944 10.1001/jamadermatol.2022.5390
104. Wei C Mustafa A Strange J Association of chronic kidney disease with hidradenitis suppurativa: a retrospective study JAAD Int 2024 15 36 37 10.1016/j.jdin.2023.12.005 38371670
Wei C, Mustafa A, Strange J, et al. Association of chronic kidney disease with hidradenitis suppurativa: a retrospective study. JAAD Int. 2024;15:36–7. 10.1016/j.jdin.2023.12.005.38371670 10.1016/j.jdin.2023.12.005
105. Maher RL Hanlon J Hajjar ER Clinical consequences of polypharmacy in elderly Expert Opin Drug Saf 2014 13 57 65 10.1517/14740338.2013.827660 24073682
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65. 10.1517/14740338.2013.827660.24073682 10.1517/14740338.2013.827660
106. Soraci L Cherubini A Paoletti L Safety and tolerability of antimicrobial agents in the older patient Drugs Aging 2023 40 499 526 10.1007/s40266-023-01019-3 36976501
Soraci L, Cherubini A, Paoletti L, et al. Safety and tolerability of antimicrobial agents in the older patient. Drugs Aging. 2023;40:499–526. 10.1007/s40266-023-01019-3.36976501 10.1007/s40266-023-01019-3
107. Hambly R Kearney N Hughes R Metformin treatment of hidradenitis suppurativa: effect on metabolic parameters, inflammation, cardiovascular risk biomarkers, and immune mediators Int J Mol Sci 2023 24 6969 10.3390/ijms24086969 37108132
Hambly R, Kearney N, Hughes R, et al. Metformin treatment of hidradenitis suppurativa: effect on metabolic parameters, inflammation, cardiovascular risk biomarkers, and immune mediators. Int J Mol Sci. 2023;24:6969. 10.3390/ijms24086969.37108132 10.3390/ijms24086969
108. Butler JV McAvoy H McEnroy D Mulkerrin EC Spironolactone therapy in older patients—the impact of renal dysfunction Arch Gerontol Geriatr 2002 35 45 49 10.1016/s0167-4943(01)00214-x 14764343
Butler JV, McAvoy H, McEnroy D, Mulkerrin EC. Spironolactone therapy in older patients—the impact of renal dysfunction. Arch Gerontol Geriatr. 2002;35:45–9. 10.1016/s0167-4943(01)00214-x.14764343 10.1016/s0167-4943(01)00214-x
109. Munar MY, Singh H. Drug dosing adjustments in patients with chronic kidney disease. Am Fam Physician. 2007;75(10):1487–1496.
110. Amarapurkar DN Prescribing medications in patients with decompensated liver cirrhosis Int J Hepatol 2011 2011 519526 10.4061/2011/519526 21994861
Amarapurkar DN. Prescribing medications in patients with decompensated liver cirrhosis. Int J Hepatol. 2011;2011: 519526. 10.4061/2011/519526.21994861 10.4061/2011/519526
111. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052–2081.
112. Menter A Strober BE Kaplan DH Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics J Am Acad Dermatol 2019 80 1029 1072 10.1016/j.jaad.2018.11.057 30772098
Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80:1029–72. 10.1016/j.jaad.2018.11.057.30772098 10.1016/j.jaad.2018.11.057
113. Pellegrini C Esposito M Rossi E Secukinumab in patients with psoriasis and a personal history of malignancy: a multicenter real-life observational study Dermatol Ther 2022 12 2613 2626 10.1007/s13555-022-00797-9
Pellegrini C, Esposito M, Rossi E, et al. Secukinumab in patients with psoriasis and a personal history of malignancy: a multicenter real-life observational study. Dermatol Ther. 2022;12:2613–26. 10.1007/s13555-022-00797-9.10.1007/s13555-022-00797-9
114. Baquero GA Rich MW Perioperative care in older adults J Geriatr Cardiol JGC 2015 12 465 469 10.11909/j.issn.1671-5411.2015.05.018 26512235
Baquero GA, Rich MW. Perioperative care in older adults. J Geriatr Cardiol JGC. 2015;12:465–9. 10.11909/j.issn.1671-5411.2015.05.018.26512235 10.11909/j.issn.1671-5411.2015.05.018
115. US Food and Drug Administration. 018662s059lbl.pdf. In: ACCUTANE® Isotretinoin Capsul. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/018662s059lbl.pdf (2008). Accessed 7 July 2024.
116. Provini LE Stellar JJ Stetzer MN Combination hyperbaric oxygen therapy and ustekinumab for severe hidradenitis suppurativa Pediatr Dermatol 2019 36 381 383 10.1111/pde.13775 30805965
Provini LE, Stellar JJ, Stetzer MN, et al. Combination hyperbaric oxygen therapy and ustekinumab for severe hidradenitis suppurativa. Pediatr Dermatol. 2019;36:381–3. 10.1111/pde.13775.30805965 10.1111/pde.13775
117. Paller AS Ladizinski B Mendes-Bastos P Efficacy and safety of upadacitinib treatment in adolescents with moderate-to-severe atopic dermatitis: analysis of the measure up 1, measure up 2, and AD up randomized clinical trials JAMA Dermatol 2023 159 526 535 10.1001/jamadermatol.2023.0391 37043227
Paller AS, Ladizinski B, Mendes-Bastos P, et al. Efficacy and safety of upadacitinib treatment in adolescents with moderate-to-severe atopic dermatitis: analysis of the measure up 1, measure up 2, and AD up randomized clinical trials. JAMA Dermatol. 2023;159:526–35. 10.1001/jamadermatol.2023.0391.37043227 10.1001/jamadermatol.2023.0391
118. Bookstaver PB Bland CM Griffin B A review of antibiotic use in pregnancy Pharmacotherapy 2015 35 1052 1062 10.1002/phar.1649 26598097
Bookstaver PB, Bland CM, Griffin B, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015;35:1052–62. 10.1002/phar.1649.26598097 10.1002/phar.1649
119. Vauzelle C Amoxicillin-clavulanic acid in late pregnancy Gynecol Obstet Fertil Senol 2022 50 205 207 10.1016/j.gofs.2021.12.008 34954405
Vauzelle C. Amoxicillin-clavulanic acid in late pregnancy. Gynecol Obstet Fertil Senol. 2022;50:205–7. 10.1016/j.gofs.2021.12.008.34954405 10.1016/j.gofs.2021.12.008
120. Daniel S Doron M Fishman B The safety of amoxicillin and clavulanic acid use during the first trimester of pregnancy Br J Clin Pharmacol 2019 85 2856 2863 10.1111/bcp.14118 31486528
Daniel S, Doron M, Fishman B, et al. The safety of amoxicillin and clavulanic acid use during the first trimester of pregnancy. Br J Clin Pharmacol. 2019;85:2856–63. 10.1111/bcp.14118.31486528 10.1111/bcp.14118
121. Sheehy O Santos F Ferreira E Bérard A The use of metronidazole during pregnancy: a review of evidence Curr Drug Saf 2015 10.2174/157488631002150515124548 25986038
Sheehy O, Santos F, Ferreira E, Bérard A. The use of metronidazole during pregnancy: a review of evidence. Curr Drug Saf. 2015. 10.2174/157488631002150515124548.25986038 10.2174/157488631002150515124548
122. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Cephalexin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501487/. Accessed 18 Jan 2021.
123. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Cefdinir. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501314/. Accessed 31 Oct 2018.
124. Benyamini L Merlob P Stahl B The safety of amoxicillin/clavulanic acid and cefuroxime during lactation Ther Drug Monit 2005 27 499 502 10.1097/01.ftd.0000168294.25356.d0 16044108
Benyamini L, Merlob P, Stahl B, et al. The safety of amoxicillin/clavulanic acid and cefuroxime during lactation. Ther Drug Monit. 2005;27:499–502. 10.1097/01.ftd.0000168294.25356.d0.16044108 10.1097/01.ftd.0000168294.25356.d0
125. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Rifampin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501348/. Accessed 15 Oct 2023.
126. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Ertapenem. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501585/. Accessed 18 Apr 2022.
127. Hyer S Balani J Shehata H Metformin in pregnancy: mechanisms and clinical applications Int J Mol Sci 2018 19 1954 10.3390/ijms19071954 29973490
Hyer S, Balani J, Shehata H. Metformin in pregnancy: mechanisms and clinical applications. Int J Mol Sci. 2018;19:1954. 10.3390/ijms19071954.29973490 10.3390/ijms19071954
128. Thatcher SS Jackson EM Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin Fertil Steril 2006 85 1002 1009 10.1016/j.fertnstert.2005.09.047 16580387
Thatcher SS, Jackson EM. Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin. Fertil Steril. 2006;85:1002–9. 10.1016/j.fertnstert.2005.09.047.16580387 10.1016/j.fertnstert.2005.09.047
129. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Spironolactone. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501101/. Accessed 15 Nov 2023.
130. Glueck CJ Salehi M Sieve L Wang P Growth, motor, and social development in breast- and formula-fed infants of metformin-treated women with polycystic ovary syndrome J Pediatr 2006 148 628 632 10.1016/j.jpeds.2006.01.011 16737874
Glueck CJ, Salehi M, Sieve L, Wang P. Growth, motor, and social development in breast- and formula-fed infants of metformin-treated women with polycystic ovary syndrome. J Pediatr. 2006;148:628–32. 10.1016/j.jpeds.2006.01.011.16737874 10.1016/j.jpeds.2006.01.011
131. Clowse MEB Scheuerle AE Chambers C Pregnancy outcomes after exposure to certolizumab pegol Arthritis Rheumatol Hoboken NJ 2018 70 1399 1407 10.1002/art.40508
Clowse MEB, Scheuerle AE, Chambers C, et al. Pregnancy outcomes after exposure to certolizumab pegol. Arthritis Rheumatol Hoboken NJ. 2018;70:1399–407. 10.1002/art.40508.10.1002/art.40508
132. Matro R Martin CF Wolf D Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development Gastroenterology 2018 155 696 704 10.1053/j.gastro.2018.05.040 29857090
Matro R, Martin CF, Wolf D, et al. Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology. 2018;155:696–704. 10.1053/j.gastro.2018.05.040.29857090 10.1053/j.gastro.2018.05.040
133. Ben-Horin S Yavzori M Katz L Adalimumab level in breast milk of a nursing mother Clin Gastroenterol Hepatol 2010 8 475 476 10.1016/j.cgh.2009.11.023 20005982
Ben-Horin S, Yavzori M, Katz L, et al. Adalimumab level in breast milk of a nursing mother. Clin Gastroenterol Hepatol. 2010;8:475–6. 10.1016/j.cgh.2009.11.023.20005982 10.1016/j.cgh.2009.11.023
134. Grosen A Julsgaard M Kelsen J Christensen LA Infliximab concentrations in the milk of nursing mothers with inflammatory bowel disease J Crohns Colitis 2014 8 175 176 10.1016/j.crohns.2013.09.003 24090905
Grosen A, Julsgaard M, Kelsen J, Christensen LA. Infliximab concentrations in the milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis. 2014;8:175–6. 10.1016/j.crohns.2013.09.003.24090905 10.1016/j.crohns.2013.09.003
135. Steen JS Stainton-Ellis DM Rifampicin in pregnancy Lancet Lond Engl 1977 2 604 605 10.1016/s0140-6736(77)91447-7
Steen JS, Stainton-Ellis DM. Rifampicin in pregnancy. Lancet Lond Engl. 1977;2:604–5. 10.1016/s0140-6736(77)91447-7.10.1016/s0140-6736(77)91447-7
136. Padberg S Wacker E Meister R Observational cohort study of pregnancy outcome after first-trimester exposure to fluoroquinolones Antimicrob Agents Chemother 2014 58 4392 4398 10.1128/AAC.02413-14 24841264
Padberg S, Wacker E, Meister R, et al. Observational cohort study of pregnancy outcome after first-trimester exposure to fluoroquinolones. Antimicrob Agents Chemother. 2014;58:4392–8. 10.1128/AAC.02413-14.24841264 10.1128/AAC.02413-14
137. Sanders SW Zone JJ Foltz RL Hemolytic anemia induced by dapsone transmitted through breast milk Ann Intern Med 1982 96 465 466 10.7326/0003-4819-96-4-465 7065565
Sanders SW, Zone JJ, Foltz RL, et al. Hemolytic anemia induced by dapsone transmitted through breast milk. Ann Intern Med. 1982;96:465–6. 10.7326/0003-4819-96-4-465.7065565 10.7326/0003-4819-96-4-465
138. Gürpinar AN Balkan E Kiliç N The effects of a fluoroquinolone on the growth and development of infants J Int Med Res 1997 25 302 306 10.1177/030006059702500508 9364293
Gürpinar AN, Balkan E, Kiliç N, et al. The effects of a fluoroquinolone on the growth and development of infants. J Int Med Res. 1997;25:302–6. 10.1177/030006059702500508.9364293 10.1177/030006059702500508
139. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Moxifloxacin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501040/. Accessed 15 July 2024.
140. Passmore CM McElnay JC Rainey EA D’Arcy PF Metronidazole excretion in human milk and its effect on the suckling neonate Br J Clin Pharmacol 1988 26 45 51 10.1111/j.1365-2125.1988.tb03362.x 3203060
Passmore CM, McElnay JC, Rainey EA, D’Arcy PF. Metronidazole excretion in human milk and its effect on the suckling neonate. Br J Clin Pharmacol. 1988;26:45–51. 10.1111/j.1365-2125.1988.tb03362.x.3203060 10.1111/j.1365-2125.1988.tb03362.x
141. Burmester GR Landewé R Genovese MC Adalimumab long-term safety: infections, vaccination response and pregnancy outcomes in patients with rheumatoid arthritis Ann Rheum Dis 2017 76 414 417 10.1136/annrheumdis-2016-209322 27338778
Burmester GR, Landewé R, Genovese MC, et al. Adalimumab long-term safety: infections, vaccination response and pregnancy outcomes in patients with rheumatoid arthritis. Ann Rheum Dis. 2017;76:414–7. 10.1136/annrheumdis-2016-209322.27338778 10.1136/annrheumdis-2016-209322
142. Saavedra MA Romo-Rodríguez R Gutiérrez-Ureña SR Targeted drugs in spondyloarthritis during pregnancy and lactation Pharmacol Res 2018 136 21 28 10.1016/j.phrs.2018.08.009 30125669
Saavedra MA, Romo-Rodríguez R, Gutiérrez-Ureña SR, et al. Targeted drugs in spondyloarthritis during pregnancy and lactation. Pharmacol Res. 2018;136:21–8. 10.1016/j.phrs.2018.08.009.30125669 10.1016/j.phrs.2018.08.009
143. Duran B Gursoy S Cetin M The oral toxicity of resorcinol during pregnancy: a case report J Toxicol Clin Toxicol 2004 42 663 666 10.1081/clt-200026966 15462161
Duran B, Gursoy S, Cetin M, et al. The oral toxicity of resorcinol during pregnancy: a case report. J Toxicol Clin Toxicol. 2004;42:663–6. 10.1081/clt-200026966.15462161 10.1081/clt-200026966
144. Vennila V Madhu V Rajesh R Tetracycline-induced discoloration of deciduous teeth: case series J Int Oral Health JIOH 2014 6 115 119 25083046
Vennila V, Madhu V, Rajesh R, et al. Tetracycline-induced discoloration of deciduous teeth: case series. J Int Oral Health JIOH. 2014;6:115–9.25083046
145. Prakash O Mathur GP Kushwaha KP Singh YD Drug exposure in pregnant and lactating mothers in periurban areas Indian Pediatr 1990 27 1301 1302 2093678
Prakash O, Mathur GP, Kushwaha KP, Singh YD. Drug exposure in pregnant and lactating mothers in periurban areas. Indian Pediatr. 1990;27:1301–2.2093678
146. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Tetracycline. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501108/. Accessed 23 Feb 2021.
147. Liszewski W Boull C Lack of evidence for feminization of males exposed to spironolactone in utero: a systematic review J Am Acad Dermatol 2019 80 1147 1148 10.1016/j.jaad.2018.10.023 30352280
Liszewski W, Boull C. Lack of evidence for feminization of males exposed to spironolactone in utero: a systematic review. J Am Acad Dermatol. 2019;80:1147–8. 10.1016/j.jaad.2018.10.023.30352280 10.1016/j.jaad.2018.10.023
148. BinJadeed HF Alajlan A Pregnancy and neonatal outcome with maternal exposure to finasteride: case series J Dermatol Dermatol Surg 2021 25 84 10.4103/jdds.jdds_33_21
BinJadeed HF, Alajlan A. Pregnancy and neonatal outcome with maternal exposure to finasteride: case series. J Dermatol Dermatol Surg. 2021;25:84. 10.4103/jdds.jdds_33_21.10.4103/jdds.jdds_33_21
149. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Finasteride. 2022 Oct. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582707/.
150. U.S. Food and Drug Administration. 211675s003lbl.pdf. In: RINVOQ® Upadacitinib. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/211675s003lbl.pdf (2022). Accessed 7 July 2024.
151. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Upadacitinib. Available from: https://www.ncbi.nlm.nih.gov/books/NBK561138/. Accessed 18 Jan 2021.
152. Lloyd ME Carr M Mcelhatton P The effects of methotrexate on pregnancy, fertility and lactation QJM Int J Med 1999 92 551 563 10.1093/qjmed/92.10.551
Lloyd ME, Carr M, Mcelhatton P, et al. The effects of methotrexate on pregnancy, fertility and lactation. QJM Int J Med. 1999;92:551–63. 10.1093/qjmed/92.10.551.10.1093/qjmed/92.10.551
153. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Methotrexate. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501341/. Accessed 15 Dec 2023.
