Table of ContentsView All
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Table of Contents
What Is the Hurley System?
Statistics About HS
Complications With Sinus Tracts
Tips for Living Well
Frequently Asked Questions
Hidradenitis suppurativa(HS) symptoms are diagnosed based on the Hurley system, which describes abscess location and severity.
Verywell / Dennis Madamba
This article will review the Hurley system, used to stage hidradenitis suppurativa symptom progression, and how each stage is defined.
Hidradenitis suppurativa symptoms can range from mild to severe.In 1989, a dermatologist named Hurley developed a scoring system based on the presence of wounds that have formed tunnels under the skin (sinus tracts) and scarring to diagnose the disease’s progression.
Dubbed the Hurley Stages, this system is now used to classify people with hidradenitis suppurativa into three categories based on the severity of symptoms:
The exact prevalence of hidradenitis suppurativa is difficult to determine. A number of studies have attempted to establish how common the disease is using a variety of methods. As a result, the estimated prevalence of hidradenitis suppurativa ranges from between 0.03% to 4% of the population.
Studies have reported that stages I and II of the disease are the most common stages in those diagnosed with hidradenitis suppurativa.
Some studies suggest stages I and II impact between 24% and 68% of people with hidradenitis suppurativa, while other studies estimate the prevalence as between 28% and 54% of people with hidradenitis suppurativa.
It is believed that stage III of the disease is the least common, affecting between 2% and 29% of those with hidradenitis suppurativa.
Studies note, however, that these figures don’t account for the number of people living undiagnosed with hidradenitis suppurativa.
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Symptoms of hidradenitis suppurativa vary based on severity and stage of the disease.
Stage I
Other symptoms may include:
Stage II
In the second stage of hidradenitis suppurativa, symptoms may include:
Stage III
In the final and most severe stage of the disease, symptoms may include:
In many cases, especially if left untreated, a mild case of hidradenitis suppurativa will worsen, leading to the formation of sinus tracts and abscesses.
In stages II and III of the disease, sinus tracts may appear. These are tunnel-like cavities that form under the skin and can interconnect. The tunnels often cause pain and scarring.
Abscesses may also form in stages II and III of the disease. An abscess is a larger lump that holds pus. In hidradenitis suppurativa, the abscesses may join together and be very painful. They may break open and leak pus, blood, and fluid. These sores can stain clothes and also cause a foul smell.
The constant bursting-then-healing of abscesses can cause permanent scarring.
Treatment is necessary to try and prevent hidradenitis suppurativa from progressing. Treatment options vary based on the stage of the disease. Treatments include medication, procedures or surgeries, skin care, and pain management.
The second stage of the disease may require stronger treatments. These may be given if earlier treatment options have been unsuccessful. Treatment options for stage II may include:
In the most severe stage of the disease, a multi-pronged approach to treatment may be necessary. As well as the above treatment options, other treatments include:
Hidradenitis suppurativa can be a challenging condition, and many with the disease may experience depression. Talking with a counselor or joining a support group may help.
Other tips for living with the disease and improving symptoms include:
A Word From Verywell
Fortunately, treatment options are available for symptoms of hidradenitis suppurativa. Consult your healthcare provider as soon as lumps begin to appear, as early interventions can help get the condition under control and prevent it from progressing to a more painful and serious stage.
Frequently Asked QuestionsHidradenitis suppurativa can progress over time. Symptoms may begin with itching and only a few lumps, but progress to abscesses that burst and ooze pus, interconnecting tunnels deep under the skin (sinus tracts), and eventual scarring.The exact cause of hidradenitis suppurativa (acne inversa) remains unknown. But researchers believe it may be related to hair follicles becoming clogged and infected with bacteria.Hidradenitis suppurativa is not an autoimmune disease. It is a chronic, inflammatory skin disease that may progress in severity.
Hidradenitis suppurativa can progress over time. Symptoms may begin with itching and only a few lumps, but progress to abscesses that burst and ooze pus, interconnecting tunnels deep under the skin (sinus tracts), and eventual scarring.
The exact cause of hidradenitis suppurativa (acne inversa) remains unknown. But researchers believe it may be related to hair follicles becoming clogged and infected with bacteria.
Hidradenitis suppurativa is not an autoimmune disease. It is a chronic, inflammatory skin disease that may progress in severity.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Hidradenitis suppurativa.Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG.A novel severity assessment scoring system for hidradenitis suppurativa.JAMA Dermatol. 2018;154(3):330-335. doi:10.1001/jamadermatol.2017.5890DermNet NZ.Hidradenitis suppurativa.Calao M, Wilson JL, Spelman L, et al.Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study.PLOS ONE. 2018;13(7):e0200683. doi:10.1371/journal.pone.0200683American Academy of Dermatology Association.Hidradenitis suppurativa: signs and symptoms.National Organization for Rare Disorders.Hidradenitis suppurativa.American Academy of Dermatology Association.Hidradenitis suppurativa: diagnosis and treatment.American Academy of Dermatology Association.Hidradenitis suppurativa: tips for managing.American Academy of Dermatology Association.Hidradenitis suppurativa: who gets and cause.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Hidradenitis suppurativa.Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG.A novel severity assessment scoring system for hidradenitis suppurativa.JAMA Dermatol. 2018;154(3):330-335. doi:10.1001/jamadermatol.2017.5890DermNet NZ.Hidradenitis suppurativa.Calao M, Wilson JL, Spelman L, et al.Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study.PLOS ONE. 2018;13(7):e0200683. doi:10.1371/journal.pone.0200683American Academy of Dermatology Association.Hidradenitis suppurativa: signs and symptoms.National Organization for Rare Disorders.Hidradenitis suppurativa.American Academy of Dermatology Association.Hidradenitis suppurativa: diagnosis and treatment.American Academy of Dermatology Association.Hidradenitis suppurativa: tips for managing.American Academy of Dermatology Association.Hidradenitis suppurativa: who gets and cause.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Hidradenitis suppurativa.Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG.A novel severity assessment scoring system for hidradenitis suppurativa.JAMA Dermatol. 2018;154(3):330-335. doi:10.1001/jamadermatol.2017.5890DermNet NZ.Hidradenitis suppurativa.Calao M, Wilson JL, Spelman L, et al.Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study.PLOS ONE. 2018;13(7):e0200683. doi:10.1371/journal.pone.0200683American Academy of Dermatology Association.Hidradenitis suppurativa: signs and symptoms.National Organization for Rare Disorders.Hidradenitis suppurativa.American Academy of Dermatology Association.Hidradenitis suppurativa: diagnosis and treatment.American Academy of Dermatology Association.Hidradenitis suppurativa: tips for managing.American Academy of Dermatology Association.Hidradenitis suppurativa: who gets and cause.
MedlinePlus.Hidradenitis suppurativa.
Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG.A novel severity assessment scoring system for hidradenitis suppurativa.JAMA Dermatol. 2018;154(3):330-335. doi:10.1001/jamadermatol.2017.5890
DermNet NZ.Hidradenitis suppurativa.
Calao M, Wilson JL, Spelman L, et al.Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study.PLOS ONE. 2018;13(7):e0200683. doi:10.1371/journal.pone.0200683
American Academy of Dermatology Association.Hidradenitis suppurativa: signs and symptoms.
National Organization for Rare Disorders.Hidradenitis suppurativa.
American Academy of Dermatology Association.Hidradenitis suppurativa: diagnosis and treatment.
American Academy of Dermatology Association.Hidradenitis suppurativa: tips for managing.
American Academy of Dermatology Association.Hidradenitis suppurativa: who gets and cause.
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