The Stages of Hidradenitis Suppurativa...

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Medically reviewed by Deeptej Singh, MDMedically reviewed by Deeptej Singh, MDHidradenitis suppurativa (HS) is a chronic (long-term) inflammatory skin condition that causes painful lesions on the skin that touches other skin. These lesions can look like small, inflamed lumps, pus-filled abscesses, pus-filled tunnels, or sinus tracts that cause permanent scarring. However, your exact symptoms will depend on what stage of the HS you're in.A staging system called the Hurley Clinical Staging System, developed in 1989, helps determine the severity of HS and offers appropriate treatment options depending on your symptoms. Stage I is mild, stage II is moderate, and stage III is severe. If left untreated, HS progresses quickly to stage III and can result in serious complications such as difficulty performing daily activities, anemia, arthritis, or skin cancer.How To Determine What HS Stage You're InDiagnosing hidradenitis suppurativa (HS) can sometimes be challenging because no specific diagnostic tests can confirm whether you have the condition. Symptoms of HS can also mimic signs of other skin conditions, making diagnosis even more difficult. However, your primary healthcare provider or dermatologist (a doctor who specializes in skin conditions) can determine if you have HS by looking for lesions that cause symptoms like:Small, inflamed lumps or nodulesAbscesses, or painful pockets of pusScarring, due to your abscesses breaking openSinus tracts, or pus-filled tunnels that develop when the abscess affects the same part of your skinBlackhead-like spots or bumpsThese skin lesions often develop in areas of the body where the skin touches the skin, such as your armpits, inner thighs, genitals, or under the breasts. In some cases, lesions can also develop on the face, back, or ear.To determine the exact stage of HS you're in, your healthcare team will use the Hurley Clinical Staging System. This is the most commonly used staging system for HS and is also helpful in telehealth appointments where physical examinations are not possible.Here's a brief overview of each stage in the Hurley Clinical Staging System:

Stage

Description

Hurley stage I

Isolated single or multiple abscesses with no sinus tracts or scarring

Hurley stage II

Recurrent abscesses with sinus tracts and scarring

Hurley stage III

Multiple interconnected sinus tracts and abscesses that affect a widespread area of skin

Hurley Stage IHurley stage I is mild hidradenitis suppurativa, which can cause the following symptoms:Small lumps that look like acne or boilsBurning or itching on the skin where the lumps appearPainful, pus-filled lumps (known as abscesses)TreatmentTo treat stage I HS, healthcare providers may recommend the following options:Lifestyle changes: Maintain a weight that's right for you and avoid smokingSkincare: Use mild antimicrobial washes, wear loose-fitted clothes, avoid waxing or shaving affected skin, and limit exposure to hot weather to avoid sweatingTopical medications: Apply antibiotics such as Cleocin (clindamycin) and antiseptics like Resinol (resorcinol) on the skin to treat inflammation and reduce the number of lesionsOral medications: Take medicines like Sumycin (tetracycline) to help improve symptoms when topical treatments aren't helping your skinCorticosteroid injections: Get steroid injections to relieve inflammation if other treatments haven't workedTreatment in this stage is necessary and important. Without treatment, stage I of HS can quickly progress to stage II.Hurley Stage IIHurley stage II is moderate HS, which causes symptoms such as:Recurring lumps and pus-filled abscessesLumps that appear in more than one part of the bodyAbscesses that may break open and form a scar when they healRepeated abscesses and scarring on the same part of your skin, which can cause sinus tractsTreatmentTreatment options for stage II HS include:Oral antibiotics: Sumycin (tetracycline) or a combination of Cleocin (clindamycin) and Rifadin (rifampin) can help reduce lesions and treat infections.Oral retinoids: Neotigason (acitretin) reduces inflammation.Hormone therapy: Aldactone (spironolactone) or other birth control pills can reduce the presence of lesions and improve inflammation/Other drugs: Axpinet (metformin) is a common diabetes medication that can also help reduce inflammation for people with HS/Surgery: Removing the lesions via incision and drainage, electrosurgery, or cryosurgery may be necessary to prevent your HS from progressing to stage III/Hurley Stage IIIHurley stage III is severe Hs, which is challenging to treat. In this stage, lesions are quite widespread, with multiple interconnected sinus tracts. These symptoms may also cause:Painful lumps that are spread across the bodyBlackhead-like spots that appear in pairsPermanent scarringDifficulty moving if lesions are causing too much painTreatmentHealthcare providers use these treatments to help reduce symptoms during stage III:Biologics: Humira (adalimumab) targets the immune system and helps reduce symptoms of current lesions and prevent the recurrence of new onesSurgery: Wide surgical excision and laser surgery can remove lesionsIt's worth noting that despite these treatments, HS in this stage can still come back. Getting early treatment for HS is key, as treatments in previous stages can improve symptoms and quality of life significantly.How To Slow HS ProgressionAlthough there is currently no cure for HS, following specific tips can slow disease progression and prevent complications. Consider the following strategies:Avoid smokingLose weight if you live with obesityEat nutritious foods, such as a diet high in lean protein, vegetables, and fruitAvoid dairy, processed foods, and foods made with yeast (e.g., breads, pastas, and certain alcohols)Wear loose-fitted clothing that don't rub against your skinAvoid sweating and staying indoors on hot daysUse mild antimicrobial washes and deodorantsDon't squeeze or pop the lumpsApply warm compresses to the affected skinLife Through the StagesLiving with HS can be challenging since the condition can affect your quality of life, especially at later stages. For some people, the boils and lumps on the skin can feel embarrassing or affect emotional health. This may cause behaviors like social isolation, decreased work performance, and mood changes. Severe cases of HS may also lead to chronic pain along with difficulty in walking or sitting.It's important to know that support and treatment are available to help you feel better regardless of where you are in your journey. If you notice that your condition is affecting your emotional and physical health significantly, consider the following coping strategies:Talking to your dermatologist and getting a customized treatment plan for youJoining an HS support group Reaching out to your loved ones about your concerns and feelingsMeeting with a psychologist or other mental health provider for supportHidradenitis suppurativa is a lifelong condition, but with proper treatment and support, you may be able to speed up healing and reduce the recurrences of the lesions. Researchers are also developing new biologic medications for treating HS, including Ilaris (canakinumab), Kineret (anakinra), and Stelara (ustekinumab). While these have yet to receive approval by the U.S. Food and Drug Administration (FDA), experts hope they will improve symptoms significantly.A Quick ReviewHS is a painful skin condition that occurs in three different stages: stage I, stage II, and stage III. To determine which stage of HS you're in, healthcare providers use the Hurley Clinical Staging System, which explains which symptoms you may be experiencing and what the recommended treatment options look like. Stage I is considered mild and treatable, stage II is moderate, and stage III is severe and difficult to treat.Getting treatment and support early can improve symptoms and quality of life. Support groups, in particular, can help you feel less alone and remind you that many other people struggle with this condition. For more Health.com news, make sure to sign up for our newsletter! Read the original article on Health.com.

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