and topical clobetasol were most commonly prescribed (Table 3). 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 (Table 2). We were unable to accurately determine the number of visits for HS in pregnant patients and pregnancy tests ordered at visits due to the relatively small frequency of patient visits.
DISCUSSION
As almost half of pregnancies are unintended, it is important that dermatologists are considering a medication’s pregnancy risk when prescribing to this population. Since only 1.84% of all visits for women of childbearing age with HS were with obstetricians, it is the responsibility of primary care physicians, surgeons, and dermatologists to facilitate conversations about potential pregnancy risk when prescribing HS therapy. Special attention should be given to safety data in the first trimester, as this is likely when the patient would be unknowingly pregnant yet still taking HS therapy.
Oral clindamycin, the most commonly prescribed medication in this study, is not recommended unless clearly needed in the first trimester of pregnancy due to lack of data.4 The third most commonly prescribed drug, minocycline, and the seventh most commonly prescribed drug, doxycycline, are well known to cause teratogenicity, teeth discoloration after in utero exposure, and hepatotoxicity in pregnant females.4 TMP-SMX, the fifth most commonly prescribed drug, should also be avoided during the first trimester due to its increased risk of neural tube defects.5
With the 2018 Food and Drug Administration approval of adalimumab for HS and the increasing evidence supporting the use of other biologics in HS treatment, prescribing patterns have likely changed since 2018.6 With increased use of biologics, there is the potential to reduce the over 31% of
