Hurley Staging for Hidradenitis Suppurativa
The Hurley staging system is the most widely used clinical classification for hidradenitis suppurativa (HS) severity. It categorizes patients into three stages based on the extent of tissue involvement, presence of sinus tracts, and scarring.
About
The Hurley staging system was described by Dr. Harry J. Hurley in 1989 as a simple clinical classification for hidradenitis suppurativa. It divides patients into three progressive stages based on the anatomical extent of disease: Stage I (abscess formation without sinus tracts or scarring), Stage II (recurrent abscesses with sinus tract formation and scarring, with single or multiple widely separated lesions), and Stage III (diffuse or near-diffuse involvement with multiple interconnected sinus tracts and abscesses across the entire affected area). The staging system guides treatment decisions: Stage I is managed with topical therapy, Stage II requires medical therapy and limited surgical procedures, and Stage III warrants wide surgical excision and biologic therapy.
Formula
Stage is determined by the presence/absence of: abscesses, sinus tracts, scarring, diffuse involvement, and interconnected sinuses.
Hurley Stage I: Abscess formation without sinus tracts or scarring. Stage II: Recurrent abscesses with sinus tracts and scarring, widely separated. Stage III: Diffuse involvement with interconnected sinus tracts. Treatment escalates with each stage: topical (I), medical + limited surgery (II), wide excision + biologic (III).
Score Interpretation
Hidradenitis suppurativa affects 1-4% of the population and is associated with significant morbidity, reduced quality of life, and increased risk of depression, anxiety, and suicide. The Hurley staging system guides treatment decisions and helps predict disease prognosis. Early diagnosis and appropriate staging are critical for optimal management.
No HS — 0–0
No evidence of hidradenitis suppurativa.
Management: No HS treatment required.
Stage I — 1–1
Mild HS. Abscess formation without sinus tracts or scarring.
Management: Topical clindamycin, lifestyle modifications.
Stage II — 2–2
Moderate HS. Recurrent abscesses with sinus tracts and scarring.
Management: Oral antibiotics, limited surgery, consider adalimumab.
Stage III — 3+
Severe HS. Diffuse involvement with interconnected sinus tracts.
Management: Wide surgical excision, adalimumab, multidisciplinary care.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Hidradenitis suppurativa patients | Stage I to Stage III | Stage I: mild, Stage II: moderate, Stage III: severe |
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View medical review board & editorial policy →Example Calculation
A patient with recurrent abscesses in both axillae with sinus tract formation and scarring, but without diffuse involvement: Hurley Stage II.
Related Conditions
Related Medications
Common Mistakes
Classifying isolated abscesses as HS without confirming the diagnosis.
HS diagnosis requires recurrent painful lesions in typical locations (axillae, groin, perineum) with chronicity.
Frequently Asked Questions
Can Hurley staging predict treatment response?
References
- Hurley HJ. Dermatologic surgery. In: Roenigk RK, Roenigk HH, eds. Dermatologic Surgery. Marcel Dekker; 1989.