Hurley Staging System for Hidradenitis Suppurativa
The Hurley staging system is the most widely 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: Characterized by 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
- The American Academy of Dermatology recommends the Hurley staging system for clinical practice due to its simplicity and ability to guide therapeutic decisions 1
- The staging system helps determine appropriate treatment selection, with different approaches recommended for each stage 1, 2
- Hurley staging is essential for the development of evidence-based treatment strategies 3
Treatment Implications Based on Hurley Stage
- Hurley Stage I (Mild Disease): Topical clindamycin 1% twice daily for 3 months is recommended as first-line treatment 3, 1
- Hurley Stage II (Moderate Disease): Systemic antibiotics such as tetracycline 500 mg twice daily or clindamycin 300 mg plus rifampicin 600 mg daily are recommended 3, 4
- Hurley Stage III (Severe Disease): Surgical procedures are recommended for extensive scarring, while biologics such as adalimumab may be required for inflammatory components 3, 1
Limitations of Hurley Staging
- The Hurley score is a static score and not sufficiently responsive to change, particularly for measuring inflammatory components of hidradenitis suppurativa 3, 1
- More dynamic scoring systems like the Hidradenitis Suppurativa Clinical Response (HiSCR) are now used in research and clinical trials to better assess treatment response 3, 1
- The HiSCR has been validated as a more responsive tool for measuring treatment effectiveness, particularly in clinical trials studying biologics like adalimumab 3
Refined Hurley Classification
- A refined version of the Hurley classification has been developed that subdivides stages I and II into three substages each (A, B, C) based on severity 5
- This refined classification has been shown to correlate well with both patient-reported quality of life measures and physician-assessed objective severity scores 5
- The refinement provides more granularity for clinical decision-making while maintaining the simplicity of the original system 5
Other Assessment Tools Used with Hurley Staging
- The Hidradenitis Suppurativa Clinical Response (HiSCR) measures the reduction in inflammatory lesions and is particularly useful for monitoring treatment response 3, 1
- The Pain Visual Analog Scale and Dermatology Life Quality Index (DLQI) are recommended as valuable adjuncts to Hurley staging in clinical practice 1
- The modified Sartorius Score is a more detailed classification system based on counting individual nodules and fistulas within anatomical regions 6
- The HS Physician's Global Assessment (PGA) describes six disease stages on a scale from 1 to 6 and is frequently used in clinical trials 6
The Hurley staging system remains the cornerstone of hidradenitis suppurativa assessment in clinical practice despite its limitations, with newer dynamic tools complementing it for research purposes and treatment monitoring 1, 7.