Women of Childbearing Age With Hidradenitis Suppurativa Frequently Prescribed Medications With Pregnancy Risk
July 2023 | Volume 22 | Issue 7 | 706 | Copyright © July 2023
Published online June 15, 2023
Gabrielle Marie Rivin , Alan B. Fleischer Jr.
aCollege of Medicine, University of Cincinnati, Cincinnati, OH
bDepartment of Dermatology, University of Cincinnati, Cincinnati OH
Abstract
Copy: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing age. As almost half of pregnancies in the United States are unplanned, dermatologists must give special consideration to medication safety when managing patients in this population.
Methods: We conducted a population-based cross-sectional analysis utilizing the National Ambulatory Medical Care Survey from 2007 to 2018 (most recent years available) in order to characterize the treatment modalities most commonly being used for treatment of hidradenitis suppurativa in women of childbearing age.
Results: There were 43.8 million estimated total visits for females ages 15 to 44 with HS. Women of childbearing age with HS were most commonly seen by general and family practice (28.6%), general surgery (26.9%), and dermatologists (24.6%). Obstetricians saw 1.84% of all visits. Oral clindamycin was the most commonly prescribed drug, followed by amoxicillin-clavulanate, minocycline, naproxen, and trimethoprim-sulfamethoxazole. Adalimumab was prescribed at an estimated 10.3 thousand visits (0.211%). At visits in which medication from the 30 most common therapies was prescribed, 31% of visits included a medication that was pregnancy category C or above.
Discussion: Nearly a third of women of childbearing age with HS are receiving medications considered teratogenic. As many female patients feel that their physicians are not counseling them regarding the impact of HS therapy on childbearing, the results of this study serve as a reminder to dermatologists and non-dermatologists managing skin disease to continue to facilitate conversations about potential pregnancy risk when prescribing medications with pregnancy risk.
Peck G, Fleischer AB Jr. Women of childbearing age with hidradenitis suppurativa frequently prescribed medications with pregnancy risk. J Drugs Dermatol. 2023;22(7):706-709. doi:10.36849/JDD.6818.
INTRODUCTION
Hzidradenitis suppurativa (HS) disproportionately affects women of childbearing age.1 In a survey of female HS patients of reproductive age, 83% reported not receiving counseling from their physician on how HS and their prescribed medications could impact childbearing.2 As almost half of pregnancies in the United States are unplanned, with women ages 18 to 24 most at risk, dermatologists must give special consideration to medication safety when managing patients in this population.2,3 To our knowledge, the treatment modalities most commonly being used for treating HS in women of childbearing age has yet to be quantified.
MATERIALS AND METHODS
We utilized the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2018, the most recent years available, for all visits where international classification of disease ninth-modification (ICD-9) code 705.83 and ICD-10 code L73.2 were a primary through quinary diagnosis. Two NAMCS pre-determined age categories, 15-24 and 25-44, defined women of childbearing potential as ages 15 to 44. The frequency of visits was determined utilizing survey procedures of SAS v9.4 (SAS Institute Inc., Cary, NC).
RESULTS
There were 43.8 million estimated total visits for females ages 15 to 44 with HS. Demographic data of the study population are included in Table 1. Women of childbearing age with HS were most commonly seen by general and family practice (28.6%), general surgery (26.9%), and dermatologists (24.6%). Obstetricians saw 1.84% of all visits. Oral clindamycin was the most commonly prescribed drug, followed by amoxicillin-clavulanate, minocycline, naproxen, and trimethoprim-sulfamethoxazole (TMP-SMX) (Table 2). Amongst patients ages 15 to 24, those at highest risk for unintended pregnancy, clindamycin, naproxen,
