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  • Denise Panter-Fixsen

Stages of HS

The severity of your HS, in any particular area, is how you are staged clinically. You can have different stages in different areas of your body and you can also be between stages at any time. How much of your body is covered with HS does not factor into the staging system. Currently the Hurley staging system is used globally and includes 3 stages. Photos of each stage are at the end of this article.


Some physicians use the PGA system, which happens more often outside of the United States, however, the Hurley staging is the most commonly used scale globally. The other scoring systems are for internal purposes including treatment evaluation, surgery assessments, insurance purposes, clinical trials, and disability purposes, etc.


The other scoring systems include: Modified Sartorius Score (MSS), Hidradenitis Suppurativa Severity Index (HSSI),Hidradenitis Suppurativa Clinical Response (HiSCR), Dermatology Life Quality Index (DLQI) and Hidradenitis Suppurativa Area and Severity Index (HASI).


The Hurley System:


The Hurley system describes three distinct clinical stages (refer to pics below).


Stage 1: Solitary or multiple isolated abscesses usually without significant scarring or sinus tracts. There can be surface discoloration scarring at stage 1 due to trauma from the abscesses.


Stage 2: Recurrent abscesses, single or multiple widely separated lesions, with scaring and sinus tract formation.


Stage 3: Diffuse or broad involvement with extensive scarring and multiple interconnected sinus tracts (tunneling) and abscesses.


There are also in between stages meaning you could be at a more severe stage 1 going into stage 2 without any tunnel formation yet, so there may be more significant scarring without the tunnel formation. You can also be in different stages in different body parts, i.e., stage 1 in your armpits and stage 2 in your groin.

Please read our article on tunneling HERE


Physician Global Assessment (PGA):


Clear: No inflammatory or noninflammatory nodules


Minimal: Only the presence of noninflammatory nodules


Mild: Fewer than five inflammatory nodules or one abscess or draining fistula and no

inflammatory nodules


Moderate: Fewer than five inflammatory nodules or one abscess or draining fistula and one or more inflammatory nodules or 2-5 abscesses or draining fistulas and fewer than 10 inflammatory nodules


Severe: Two to five abscesses or draining fistulas and 10 or more inflammatory nodules


Very severe: More than five abscesses or draining fistulas


Again, you can have different body parts in different stages.




Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.


Written by Denise Panter Fixsen

Edited by Brindley Kons Brooks

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