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Hidradenitis Suppurativa & Hurley Staging

Chronic recurrent inflammatory follicular skin disease of apocrine-bearing intertriginous areas with painful nodules, abscesses, sinus tracts, and scarring graded by Hurley I-III stages guiding therapeutic strategy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Hidradenitis Suppurativa & Hurley Staging?

Hidradenitis suppurativa (acne inversa) is a chronic, recurrent, debilitating skin disease of the terminal hair follicles in apocrine gland-bearing areas characterized by painful, deep-seated inflammatory lesions including nodules, abscesses, fistulas, and hypertrophic scars.

Pathophysiology involves follicular occlusion, dilatation, rupture, and bacterial colonization with secondary inflammation. Genetic predisposition (γ-secretase mutations 5%), obesity, smoking, mechanical friction, and hormonal factors contribute to disease pathogenesis.

Hurley staging guides treatment: Stage I (isolated abscesses without sinus tracts/scarring), Stage II (recurrent abscesses with sinus formation and scarring, isolated lesions), Stage III (multiple interconnected tracts, abscesses, and scarring across entire affected anatomical area). IHS4 and HS-PGA are dynamic severity scores.

Symptoms

Recurrent painful red nodules in axillae, groin, perianal, inframammary areas
Spontaneously rupturing abscesses with malodorous discharge
Sinus tracts and fistulas with persistent drainage
Hypertrophic and rope-like scars
Open and closed (double) comedones in affected areas
Burning, pruritus, and pain disrupting daily activities
Restricted range of motion from extensive scarring

Risk Factors

Female sex (3:1 female-to-male ratio)
Obesity (BMI >30) significantly increases severity
Smoking (90% of HS patients are current/former smokers)
Family history (35-40% with positive family history)
Onset typically post-puberty to age 40
Mechanical friction and skin folds
Comorbidities: metabolic syndrome, IBD, spondyloarthritis, PCOS
γ-Secretase gene mutations (NCSTN, PSEN1, PSENEN) in 5%

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent painful nodules in axilla or groin
  • Draining sinus tracts in inframammary or perianal area
  • Abscess formation requiring incision and drainage
  • Disabling pain limiting work or daily activities
  • Disease progression despite topical therapy
  • Failed antibiotic courses requiring escalation
  • Severe scarring with restricted mobility
  • Pre-surgical evaluation for wide excision

Treatment Methods

01
Lifestyle: smoking cessation, weight loss, loose breathable clothing, antibacterial cleansers (chlorhexidine, benzoyl peroxide)
02
Hurley I: topical clindamycin 1% twice daily, intralesional triamcinolone acetonide for acute flares
03
Hurley I-II: oral tetracyclines (doxycycline 100 mg BID 12 weeks) or clindamycin-rifampin combination
04
Hurley II-III: adalimumab 40 mg weekly (after 160 mg/80 mg loading) is first-line FDA-approved biologic
05
Secukinumab anti-IL-17A (FDA-approved 2023) and bimekizumab for refractory cases
06
Hormonal therapy: spironolactone 100-200 mg/day, oral contraceptives, finasteride for selected patients
07
Oral retinoids: isotretinoin or acitretin for chronic cases (less effective than for acne)
08
Surgical: deroofing for sinus tracts, wide local excision with secondary intention healing or skin grafting for Hurley III
09
Laser therapy: Nd:YAG laser hair removal, CO2 laser excision
10
Multidisciplinary management: dermatology, surgery, pain management, psychology for depression/anxiety

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.