Hidradenitis Suppurativa — SCE Dermatology MCQ

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EasyInflammatory DermatosesHidradenitis SuppurativaSCE Dermatology

A 28-year-old woman with hidradenitis suppurativa asks about the Hurley staging system. She has recurrent abscesses with sinus tract formation and scarring in her axillae. How many stages does the Hurley classification have and what stage does she have?

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Correct answer: A — 3 stages; Stage II (recurrent abscesses with sinus tracts and scarring)

The Hurley staging system classifies HS into three stages: Stage I — solitary or multiple abscesses without sinus tracts or cicatrisation (scarring); Stage II — recurrent abscesses with sinus tract formation and cicatrisation, widely separated lesions; Stage III — diffuse or near-diffuse involvement with multiple interconnected sinus tracts and abscesses across an entire area. The patient described has recurrent abscesses with sinus tracts and scarring = Stage II. Hurley staging is static (describes worst-ever disease state) and is used for treatment stratification: Stage I = topical therapy; Stage II = systemic antibiotics ± Adalimumab; Stage III = Adalimumab ± surgery. IHS4 is a dynamic score tracking disease activity over time.

Reference: BAD 2019 HS Guidelines; Hurley 1989