Hurley Staging System
Physician-Reported Clinical Classification
The oldest and most widely used classification for hidradenitis suppurativa severity. A qualitative, three-stage system based on the extent of abscesses, sinus tracts, and scarring, designed to guide surgical decisions.
About the Hurley
Severity Bands
| Score Range | Classification | Interpretation |
|---|---|---|
| 1 | Stage I (Mild) | Abscess formation without sinus tracts and without scarring |
| 2 | Stage II (Moderate) | Recurrent abscesses with sinus tract formation and scarring |
| 3 | Stage III (Severe) | Diffuse or near-diffuse involvement with multiple interconnected sinus tracts |
Clinical Background
The Hurley clinical staging system, first described in 1989 by Harry J. Hurley Jr., is the oldest and most widely used classification for hidradenitis suppurativa (HS) severity. It was originally designed to guide surgical treatment decisions for specific anatomical regions. The system stratifies patients into three stages based on the presence and extent of abscesses, sinus tracts (tunnels), and scarring.
Stage I (Mild): Abscess formation (single or multiple) without sinus tracts and without cicatrization or scarring. Stage II (Moderate): Recurrent abscesses with sinus tract formation and scarring; single or multiple widely separated lesions. Stage III (Severe): Diffuse or near-diffuse involvement, or multiple interconnected sinus tracts and abscesses across the entire affected area with extensive scarring and fibrosis.
The Hurley staging system is qualitative and static, meaning it reflects fixed features (scars, fistulae) rather than dynamic inflammatory activity. Different anatomical regions on the same patient may be assigned different Hurley stages. It does not account for the number of lesions, pain, quality of life impact, or disease flare frequency. For dynamic monitoring, the IHS4 is recommended alongside Hurley staging.
References
- Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach. In: Roenigk RK, Roenigk HH, eds. Dermatologic Surgery: Principles and Practice. New York: Marcel Dekker; 1989:729-739.
- Jemec GBE. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158-164. doi:10.1056/NEJMcp1014163
- Horvath B, Janse IC, Blok JL, et al.. Hurley staging refined: a proposal by the Dutch Hidradenitis Suppurativa Expert Group. Acta Derm Venereol. 2017;97(3):412-413. doi:10.2340/00015555-2513
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