Hidradenitis Suppurativa (HS) Stages

Posted on August 19, 2019

Article written by
Alison Channon

After diagnosing hidradenitis suppurativa (HS), a dermatologist or other doctor may classify each case of HS using the Hurley staging system. This system describes HS symptoms as mild, moderate, or severe. The Hurley staging system was developed by a dermatologist in 1989.1,2

Some people with mild hidradenitis suppurativa never progress to more advanced stages. However, some people’s HS symptoms can become increasingly severe if not treated. Early diagnosis and treatment can help prevent HS from becoming worse over time.3

Hurley Stage I (Mild)

  • Stage I HS involves one lesion or isolated abscesses without sinus tract formation (narrow openings underneath the skin) or scarring. HS often begins as small pea-sized bumps that are sometimes mistaken for acne or ingrown hairs.3,4
  • The vast majority of people with HS – 68 percent – fall into the mild category.2
  • Stage I HS can often be treated with oral or topical medications.5

Hurley Stage II (Moderate)

  • Stage II is defined by recurring abscesses with scarring and sinus tracts.3
  • Stage II is the second most common stage. It accounts for 28 percent of people with HS.2
  • Oral or topical medications are usually the first approach for treating stage II HS. Surgical procedures may be needed if medications don’t work.3

Hurley Stage III (Severe)

  • Stage III HS involves multiple lesions across an entire area of the body with sinus tract formations, scarring, and sometimes foul-smelling pus.1,3,4
  • Stage III accounts for a small percentage of HS cases. About 4 percent of people with HS are classified as stage III.2
  • Stage III HS can be treated with oral retinoids, immunosuppressive medications, biologics, and surgery.3

Some doctors also use a more detailed staging system called the Sartorius score. A Sartorius score considers which parts of the body are affected, the number and type of lesions, the distance between lesions, and the condition of the skin separating lesions. The Sartorius score is used more frequently in research settings than clinical practice.5


External resources

Internal Resources


  1. Hidradenitis Suppurativa. (n.d.). Retrieved June 26, 2019, from https://www.hs-foundation.org/what-is-hs
  2. Zouboulis, C., Desai, N., Emtestam, L., Hunger, R., Ioannides, D., Juhász, I., … Jemec, G. (2015). European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. Journal of the European Academy of Dermatology and Venereology,29(4), 619-644. Doi:10.1111/jdv.12966
  3. Lee, E. Y., Alhusayen, R., Lansang, P., Shear, N., & Yeung, J. (2017). What is hidradenitis suppurativa? Canadian Family Physician,63, 114-120.
  4. Hidradenitis suppurativa: Symptoms & causes. (2019, May 16). Retrieved June 26, 2019, from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306
  5. Rothstein, B., Scheinfeld, N., MD, Huang, W. W., MD, MPH, & Feldman, S. R., MD, PhD. (n.d.). The Hurley and Sartorius Systems: Two Methods of Staging HS. Retrieved July 2, 2019, from https://www.consultant360.com/exclusives/hurley-and-sartorius-systems-two-methods-staging-hs

Alison has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

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