What Is the Treatment of Hidradenitis Suppurativa — Hurley Stage III (Multiple or Extensive Sinuses / Scarring)?
Clinical Scenario
This protocol applies to adult, non-pregnant patients with hidradenitis suppurativa at Hurley stage III — the most severe disease category — characterised by multiple or extensive interconnected sinuses and significant scarring across affected body regions.
Hurley Stage III — What It Means
Hurley stage I is characterised by recurrent nodules and abscesses with minimal scar. Hurley stage II involves one or a limited number of sinuses and/or scarring within a body region. Hurley stage III is the most advanced stage — defined by multiple or extensive sinuses and/or scarring, often spanning wide areas of skin.
Treatment Approach (Overview Only)
At this severity, the structured approach includes lifestyle counselling alongside combination antibiotic therapy used as first-line or adjunct treatment, and a biologic agent option — with the complete regimen, sequencing, and all supporting detail reserved in the full protocol.
Agent selection, dosing, procedural interventions, and evidence grading are not shown here.
References
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.
- Counsel smoking cessation.
- Screen for obesity and counsel weight loss.
- Clindamycin and rifampin in combination is effective as a second-line treatment for mild-to-moderate disease or as a first-line or adjunct treatment in severe disease.
- Adalimumab at the approved HS dosing is recommended to improve disease severity and quality of life in patients with moderate-to-severe HS.
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