Hurley Staging System for Hidradenitis Suppurativa
The Hurley staging system is the oldest and most commonly used classification system for hidradenitis suppurativa, dividing the disease into three stages based on the presence of abscesses, sinus tracts, and scarring. 1
Hurley Staging Classification
- Stage I: Recurrent nodules and abscesses with minimal or no scarring 1
- Stage II: One or a limited number of sinuses and/or scarring within a body region 1
- Stage III: Multiple or extensive sinuses and/or scarring affecting an entire body region 1
Clinical Utility and Validation
- The Hurley staging system is recommended for clinical practice due to its simplicity and ability to help determine therapeutic needs 1
- It has been validated with moderate inter-rater reliability (κ = 0.59) and substantial intra-rater reliability (κ = 0.65) across all stages 2
- Reliability is highest for Hurley stage III (inter-rater κ = 0.81, intra-rater κ = 0.82), making it particularly useful for identifying severe cases requiring surgical intervention 2
- Average time to apply Hurley staging is approximately 14 seconds, making it practical for routine clinical use 2
Limitations of Hurley Staging
- The Hurley score is a static score and not sufficiently responsive to change, particularly for measuring inflammatory components of HS 1
- It does not capture the full spectrum of disease severity within each stage, leading to the development of refined classifications 3
- More dynamic scoring systems like the Hidradenitis Suppurativa Clinical Response (HiSCR) are now used in research and clinical trials to better assess treatment response 1
Treatment Implications Based on Hurley Stage
- Hurley Stage I/mild Stage II: Topical clindamycin 1% twice daily for 3 months is recommended as first-line treatment 1
- Hurley Stage I/II with widespread disease: Tetracycline 500mg twice daily for up to 4 months 1
- Hurley Stage II/III: Moderate to severe disease unresponsive to antibiotics may require biologics such as adalimumab 1, 4
- Hurley Stage III: Surgical procedures are recommended for extensive scarring 1, 5
Refined Hurley Classification
- A refined Hurley classification has been developed that subdivides stages I and II into three substages (A, B, C) based on severity 3
- This refined classification correlates well with patient-reported quality of life measures and physician-assessed objective severity scores 3
- It provides more granularity for clinical decision-making while maintaining the simplicity of the original system 3
Other Assessment Tools Used with Hurley Staging
- Pain visual analog scale and Dermatology Life Quality Index (DLQI) are valuable adjuncts to Hurley staging in clinical practice 1
- The Hidradenitis Suppurativa Clinical Response (HiSCR) is more validated for assessing treatment response in clinical trials 1
- The modified Sartorius Score is more detailed but less practical for routine clinical use 1, 6