Hidradenitis Suppurativa Stages | HS Online

Hidradenitis Suppurativa - Images of Stages

Because hidradenitis suppurativa (HS) is often mistaken for an infection, a long delay in diagnosis is not uncommon.1 Dermatologists typically assess the signs and symptoms of HS on a scale - these categories are developed from a clinical measure of severity called the Hurley scale:1,2

Hurley stage I

Single or a few isolated boils without sinus tracts (narrow channels that form under the skin and break out on the surface) or scarring1,2,8

  • These tender bumps generally start as firm, pea-sized nodules. Since they typically are red, the nodules are often mistaken for acne or an ingrown hair2-4

Hurley stage ll

Recurring boils in single or multiple areas with scarring and sinus tracts1,2

  • Recurs frequently leaving scars with normal skin in between5,6

Hurley stage lll

Widespread boils with multiple interconnected tracts across the affected area1,2

  • Multiple boils and scars with no normal skin left between them6
  • May be associated with an unpleasant smelling discharge2,7


  1. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012;366:158–164.
  2. Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2009;23:985–998.
  3. NHS Choices. Hidradenitis suppurativa. Available at: http://www.nhs.uk/conditions/hidradenitis-suppurativa/Pages/Introduction.aspx. Accessed March 28 2019.
  4. Genetics Home Reference. Hidradenitis suppurativa. U.S. National Library of Medicine. Available at: https://ghr.nlm.nih.gov/condition/hidradenitis-suppurativa. Accessed March 28 2019.
  5. Collier F, Smith R, Morton C. Diagnosis and management of hidradenitis suppurativa. BMJ 2013;346:f2121.
  6. Gill L, Williams M, Hamzavi I. Update on hidradenitis suppurativa: connecting the tracts. F1000Prime Rep 2014;6:112.
  7. Dufour ND, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgrad Med J 2014;90:216–221.
  8. http://www.nhs.uk/conditions/hidradenitis-suppurativa/Pages/Introduction.aspx. Accessed March 28 2019