Dermatologists usually grade the signs and symptoms of HS according to how severe they are on a scale which ranges from I to III, called the Hurley staging system (Hurley 1989). Dermatologists use this scale to assess disease severity and to recommend certain therapies and treatments (Zouboulis et al. 2015). The stages are described below.
Stage I HS
- Single or multiple lesions/boils without sinus tract* formation or scarring
- These lesions/boils start as painful, firm pea-sized lumps and can become inflamed to reach golf ball size
- They are frequently mistaken for acne, ingrown hairs or sexually transmitted infections
* sinus tracts: narrow opening or passageway under the skin surface that can extend in any direction through soft tissue and results in dead space with potential for abscess formation.
Stage II HS
- Recurrent single or multiple widely separated lesions, with sinus tract formation
- Significant scarring can occur due to repeated occurrences at a single location
- Depending on the location, movement (of arm, legs etc.) may be restricted
Stage III HS
- Diffuse or broad involvement, with multiple interconnected sinus tracts and abscesses
- Affected areas may have significant scarring and movement may be severely restricted
In recent years, other systems for classifying the disease have been proposed (reviewed in Zouboulis et al. 2015) but the Hurley system is still widely used.
You can be at different Hurley stages in different parts of the body at any given time.
Note that having stage I HS does not necessarily mean you will progress to stage II or III. Some people do progress to more severe forms and some do not.
Hurley H. (1989) ‘Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach,’ In: Roenigh R.R.H., ed. Dermatologic Surgery, 729–739, Marcel Dekker: New York.
Zouboulis, C.C., Desai, N., Emtestam, L., Hunger, R.E., Ioannides, D., Juhász, I., Lapins, J., Matusiak, L., Prens, E.P. Revuz, J., Schneider-Burrus, S., Szepietowski, J.C., van der Zee, H.H. and Jemec, G.B. (2015) ‘Eurpean S1 guideline for the treatment of hidradenitis suppurativa/acne inversa’, Journal of the European Academy of Dermatology and Venereology, 29(4), 619–644.