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. As of 2019 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
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.
This is an awareness article for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.
Written by Denise Panter Fixsen
Edited by Brindley Kons