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Hidradenitis suppurativa: assessment of severity

How is the severity and extent of hydradenitis evaluated?

The severity and extent of hydradenitis suppurativa should be recorded in the evaluation and in determining the impact of a treatment. Two scoring systems are in common use: Hurley Stages and Sartorius Hidradenitis Suppurativa Score.

Hurley Stages

The Hurley system describes three different clinical stages. [one].

Stage 1 - solitary or multiple, isolated abscess scarless formation or breast treaties
Stage 2 - recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation
Stage 3 - diffuse or broad participation, with multiple interconnected sinus tracts and abscesses.

Sartorius Suppurative Hidradenitis score

The Sartorius Hidradenitis Suppurativa score is performed by counting the regions involved, nodules and sinus tracts [2].

  • Anatomical region involved (armpitgenital groin gluteus, or another inflammatory left and / or right region): 3 points per region involved
  • Number and scores of injuries (abscesses, nodules, fistulas, scars): 2 points for each nodule, 4 points for each fistula, 1 point for each scar, 1 point each for "other"
  • Longest distance between 2 relevant lesions (i.e. nodules and fistulas, in each region, or size if only 1 injury): Less than 5 cm, 2 points; less than 10 cm, 4 points; more than 10 cm, 8 points
  • Lesions clearly separated by normal skin in each region: if yes, 0 points; if not, 6 points


The six-point global assessment of hydradenitis suppurativa Physician Global Assessment (PGA) varies from clear to very severe. It is used in clinical trials to measure clinical improvement in inflammatory nodules, abscesses, and drainage. fistulas [3].


The clinical response of hydradenitis suppurativa (HiSCR) is defined as a reduction of ≥ 50% in the count of inflammatory lesions (abscesses + inflammatory nodules), and no increase in abscesses or draining fistulas compared to base. It has recently been used to evaluate the effectiveness of treatment with biological products. [3].


It is also useful to consider the degree of pain, the number of flares and the impact on daily life in hidradenitis suppurativa. Cardiff Dermatology Quality of life index or DLQI questionnaire is often used.

A Suppurative Hidradenitis Disease Burden tool (HSBOD) has been described but is not fully validated [5].