Stage I (mild) | Single or multiple abscesses without sinus tracts and scarring | The following steps should be considered regardless of the severity of HS (grade F, level III):
Provide education, counseling, and support Avoid skin trauma Encourage lifestyle modifications, including weight loss and smoking cessation
| First-line treatments:
Second-line treatments:
Topical resorcinol (grade F, level II), hormonal therapy (grade F, level II), IL CCS injection (grade F, level III)
| Incision and drainage (not encouraged) |
Stage II (moderate) | Recurrent abscesses with sinus tracts and scarring | | First-line treatments:
Second-line treatments:
Third-line treatment:
| If multiple medical therapies have failed, refer to a plastic surgeon for excisions |
Stage III (severe) | Diffuse or multiple interconnected sinus tracts and abscesses across the entire area | | Refer to a dermatologist who might initiate the following:
Oral retinoids (grade F, level II) Immunosuppressive agents (grade F, level II) Biologics (grade B, level I)
| If multiple medical therapies have failed, refer to a plastic surgeon for excisions |