Hidradenitis Suppurativa Stages


Hidradenitis suppurativa is presented in three stages. Due to the wide spectrum of clinical severity and the severe impact on quality of life, a reliable method for assessing the severity of HS is required.

Hurley’s staging system

This is historically the first proposed classification system, and is still in use for the classification of patients with skin / dermatological diseases (ie, psoriasis, HS, acne). Hurley separated patients into three groups based largely on the presence and extent of scarring and sinuses. It has also been used as a basis for clinical trials in the past and is approaching a useful basis for the treatment of patients. These three stages are on Hurley staging system, which is simple and is based on the subjective extent of the diseased tissue of the patient has been based. Hurley’s three stages of hidradenitis suppurativa are as follows:



ISolitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)
IIRecurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammation restrict movement and may require minor surgery such as incision and drainage.)
IIIDiffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or  sometimes baseballs; scarring develops, including subcutaneous tracts of infection – see fistula. Obviously, patients at this stage may be unable to function.)

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Sartorious staging system

The Sartorius staging system is more demanding than Hurley. Sartorius et al. suggested that the Hurley system is not mature enough to assess treatment effects in clinical trials during the research. This classification allows a better dynamic monitoring of disease severity in individual patients. The elements of the latch system are:

– Anatomical regions involved (axilla, groin or buttocks or other infrared breast area to the left or right)

– Number and types of lesions involved (abscesses, nodules, fistulas, scars, lesions of points for all participating regions)

– The distance between the lesions, particularly the longest distance between two corresponding lesions (i.e., node and fistulas in each area or size, if any single lesion)

– The presence of normal skin between lesions (ie all lesions clearly separated by normal skin?)

Points are accumulated in each of the above categories, and added to give both a regional and total score. Furthermore, the authors recommend the addition of a visual analog scale for pain and the Dermatology Life Quality Index (DLQI, or the Skindex) in assessing the HS.

Read about Areas of Involvement and Treatment

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