Table 1.

Recommendations for HS treatment based on disease severity guided by the Hurley clinical staging system

HURLEY CLINICAL STAGING SYSTEMCHARACTERISTICSRECOMMENDED TREATMENT
NONMEDiCALPHARMACOLOGICSURGICAL
Stage I (mild)Single or multiple abscesses without sinus tracts and scarringThe 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:

  • Topical clindamycin (grade B, level II), oral tetracycline (grade B, level II)


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 scarringFirst-line treatments:

  • Topical clindamycin, oral tetracycline


Second-line treatments:

  • Topical resorcinol, hormonal therapy, IL CCS injection

Third-line treatment:

  • Refer to a dermatologist

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 areaRefer 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

  • HS—hidradenitis suppurativa, IL CCS—intralesional corticosteroid.

  • Data from Alikhan et al,3 Zouboulis et al,21 and Alhusayen et al.22