Hurley Staging Refined: A Proposal by the Dutch Hidradenitis Suppurativa Expert Group

Hurley Staging Refined: A Proposal by the Dutch Hidradenitis Suppurativa Expert Group

Hidradenitis suppurativa (HS) is a chronic, recurring, debilitating inflammatory skin disease, which mainly affects the inverse areas of the body leading to scarring and disfigurement. 

The European S1 guideline for the treatment of HS summarized all published treatments for HS. The quality of evidence for these treatments is generally low, as was recently demonstrated in a Cochrane Review on interventions for HS, which identified only 12 randomized controlled trials (RCTs). Moreover, HS is a heterogeneous disease with distinct clinical phenotypes that may require different treatment strategies, further complicating the therapeutic decision-making process.

The European S1 guideline proposed a “Hurley severity grade-relevant treatment algorithm”. More recently Gulliver et al. proposed another treatment algorithm based on disease severity measured by Hurley grade or PGA.

Hurley stage is a 3-stage classification of severity. Hurley stage I is characterized by abscess formation with-out sinus tracts and scarring. In Hurley II, patients have single or multiple separated areas of recurrent abscesses with sinus tracts and scarring, whereas in stage III the multiple interconnected sinus tracts and abscesses cover the whole affected anatomical area. This classification in its original form was created mainly for surgical purposes and does not take into account the inflammatory component. In addition, the extension of the disease, i.e. the number of anatomical areas involved, is not assessed. Accurate stratification of the wide variety of HS clinical phenotypes is therefore not possible with the original Hurley score.


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