Hidradenitis suppurativa (HS) is marked by painful acne-like boils under your skin. HS is chronic, but treating it early can help prevent complications. It is classified as mild, moderate, and severe based on the Hurley staging system.
HS was previously known as acne inversa and Verneuil’s disease. You’ll likely experience recurring symptoms over a long time.
HS develops when hairs become trapped in hair follicles, leading to inflammation deep in the skin. Bacteria may also get trapped in the follicles, leading to mild infections. As the lesions grow, they can become painful and eventually rupture.
HS is diagnosed based on examination and the presence of these infected glands. The earlier HS is detected, the sooner you can obtain treatment to help prevent complications.
Read on to learn more about the Hurley stages of HS.
The Hurley staging system was introduced by dermatologist HJ Hurley in 1989. It was intended as an instrument to allow doctors to quickly identify the appropriate treatments for HS based on the severity of the boils in affected areas.
The researchers suggested that this indicates that Hurley staging can be useful even during telemedicine appointments where healthcare professionals are unable to complete a more thorough examination.
The simplicity of this assessment is part of what makes it one of the most used instruments for assessing HS. Other staging instruments include the Sartorius Hidradenitis Suppurativa Score and the HS Physician Global Assessment (PGA).
Hurley stage 1 is the mildest clinical form of this condition. It’s marked by isolated boils that sometimes form in multiples, but without tunnel (sinus tract) formation. This stage doesn’t cause widespread abscesses or scarring that more severe HS can.
Milder cases of HS may be treated with home remedies. These include washing with antibacterial soaps, applying warm compresses, avoiding shaving, staying dry, and using antiseptics. A doctor may also recommend taking an anti-inflammatory medication.
Mild HS may also be treated with a topical steroid cream or corticosteroid injections. These help to decrease inflammation so that the boils and tracts may decrease in size and severity. Left untreated, stage 1 HS will likely develop into stage 2.
In Hurley stage 2, you may experience more moderate abscesses that may appear in more widespread areas of your body. The boils that originally developed under your skin can become further aggravated and break open, producing pus. Tract formation is possible in this stage, but it’s minimal compared to stage 3.
If topical remedies haven’t worked alone, a doctor may also prescribe oral steroids or antibiotics. These are taken temporarily to help decrease inflammation and bacterial buildup, respectively. Pain relievers may also be recommended.
Hurley stage 3 is the most severe form of HS. It’s characterized by a more broad and widespread development of HS lesions, including tract formations. Pain and scarring are also expected in this stage.
Due to this widespread and recurring nature, stage 3 can be very difficult to treat. Boils, tracts, and scars may be removed via surgery, especially if HS is starting to interfere with your quality of life. Laser therapies and hair removal may also help. Immunosuppressant drugs like adalimumab (Humira) may be used for severe cases, too.
It’s estimated that HS affects at least 1 out of every 100 people. HS is thought to have a strong genetic component, so you may have a higher risk if you have family members with this condition. It tends to develop during teenage and early adult years. Women are at a higher risk of developing HS, but it can occur in men, too.
Certain health conditions may also increase your risk of developing HS. These include:
- acne conglobata
- heart disease
- metabolic syndrome
- polycystic ovary syndrome (PCOS)
- Crohn’s disease
- history of smoking
- long-term stress
It’s important to know that having any of the above conditions doesn’t mean you’ll automatically develop HS. However, it’s important to keep an eye on your skin should any boils develop, as HS is strongly linked to these medical conditions.
HS itself can be difficult to treat, but this condition can also lead to further complications that can affect your daily life.
First, you may experience significant pain, which may be further exacerbated when you walk or move around due to the nature of the boils being located in skin folds. Such complications are even more prominent in Hurley stage 3.
While HS isn’t life threatening, widespread lesions can lead to bacterial infections. When combined with a weakened immune system, a significant bacterial infection can become potentially life threatening.
Having HS can also increase your risk of social isolation and missed days of work. It may even lead to anxiety and depression.
Many people with HS may not seek medical help right away. This is sometimes due to a previous misdiagnosis of cystic acne or other chronic skin conditions. Unlike traditional acne though, HS tends to recur in the same areas and it won’t respond to over-the-counter treatments.
Talk with a doctor about your skin condition if you experience one or more of the following:
- boil-like lesions that develop in the folds of your skin, such as the groin, breast, or neck area
- lesions that recur in the same areas
- symmetrical boils that affect both sides of your body equally
- areas of skin that are extremely painful and interfere with your daily activities
There’s currently no cure for HS, so it’s important to seek treatment as soon as possible. This will help decrease the lesions and underlying inflammation and bacteria that can make this skin condition worse.
Treatments can reduce pain and the incidence of scarring, which can improve your overall quality of life. The more severe your HS, the more aggressive the treatment measures may be.
If you find that your current HS treatment isn’t improving your skin lesions, you may need to see a specialist like a dermatologist or even a surgeon to explore other options.