The 3 Hidradenitis Suppurativa (HS) Stages and Tips to Manage Them

Hidradenitis suppurativa (HS) is a long-term skin condition. It involves inflammation and painful nodules under the skin. In advanced HS stages, it can also lead to deep abscess formation and serious scarring. HS can look like pimples or boils, but it’s much more severe.

HS can be a debilitating skin condition when left untreated. But there are things that may help decrease the likelihood of frequent flare-ups or worsening of HS. Let’s take a closer look at the stages of HS and tips for managing the condition. 

What is the Hurley staging system? 

The Hurley staging system was developed as a way to classify the severity of HS symptoms. There are three Hurley stages and they’re used to follow the progression of HS. The Hurley stages are also used by your healthcare provider to determine the best treatment options for you. 

Hurley stage 1 

Hurley stage 1 is considered a mild version of HS. You may have one or more nodules with abscess formation. But with this stage, there’s no scarring. Treatment for this stage is usually topical medication applied directly to the HS lesions.

Hurley stage 2 

Hurley stage 2 is classified as moderate HS disease. In this stage, you may have recurring nodules and abscesses. These abscesses can be spread apart but connected by a tunnel underneath the skin. Scarring of the skin is common as the lesions heal. Treatment may be a combination of topical and oral antibiotics.

Hurley stage 3

Hurley stage 3 is severe HS. With this stage, there’s often widespread skin disease. There are likely multiple nodules and abscesses with tunnels or sinus tracts connecting them over a large area. 

Treatment often requires surgery or a biologic injection. Adalimumab (Humira) is the only FDA-approved HS treatment for HS. It targets the immune system to decrease inflammation.

How quickly does HS progress (and how can you stop it)? 

The earlier HS is diagnosed, the earlier it can be treated. This can help to prevent the progression of HS and significant scarring. 

There’s no cure for HS, but treatment can help manage the disease and reduce the frequency of flare-ups. 

Treatment options for HS depend on your Hurley stage. Treatment options can vary from topical treatments, oral medications, injections, or surgery. These options can be used individually or in combination with each other. 

How can you care for HS at home?

If you develop a nodule or abscess and cannot get in to see your healthcare provider immediately, a warm compress can provide relief. The heat will help decrease the inflammation and help with the pain. 

When making a warm compress, it’s important to use clean washcloths and make sure that the compress is not too hot so you don’t burn yourself. You can leave the warm compress in place for about 10 minutes and repeat several times a day for relief.

Other ways you can manage HS and decrease complications are to:

• Stop smoking cigarettes (or don’t start).

• Make a plan to manage excess weight.

• Limit excess sweating.

• Wash your skin using antimicrobial soap.

• Use a mild deodorant that’s not too strong.

• Avoid tight-fitting clothes.

• Avoid too much friction on the skin (like rubbing too hard).

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Written by:

Valerie Emuakhagbon, MD

Valerie Emuakhagbon, MD, is a board-certified colorectal surgeon. A native of Dallas, Texas, she completed the six-year BA/MD program at the University of Missouri-Kansas City.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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