This protocol applies to adult, non-pregnant patients with hidradenitis suppurativa classified at Hurley stage I — presenting with recurrent nodules and abscesses and minimal scar formation.
Hurley stage I is characterised by recurrent nodules and abscesses with minimal scar. At this stage, sinus tracts are absent and scarring is minimal, distinguishing it from more advanced Hurley stages where sinuses and significant scarring are present.
For patients at this stage who have not responded to earlier interventions, third-line oral therapeutic options are available. In eligible female patients, hormonal approaches form a distinct part of the armamentarium. The complete sequencing, agent selection, and clinical guidance are in the full protocol.
DOI: 10.1016/j.jaad.2019.02.067
Hurley stage I is characterized by recurrent nodules and abscesses with minimal scar, Hurley stage II is characterized by 1 or a limited number of sinuses and/or scarring within a body region, and Hurley stage III is characterized by multiple or extensive sinuses and/or scarring.
Dapsone may be effective for a minority of patients with Hurley stage I or II disease as long-term maintenance therapy. Given the low response rates and need for monitoring, dapsone is reserved as third-line treatment in Hurley stage I or II disease.
Hormonal agents, including estrogen-containing combined oral contraceptives, spironolactone, cyproterone acetate, metformin, and finasteride, should be considered in appropriate female patients, either as monotherapy for mild-to-moderate HS or in combination with other agents for more severe disease.
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