Hidradenitis suppurativa
ICD-10 L73.2 · ICD-11 ED92.0

Treatment of Hidradenitis Suppurativa at Hurley Stage III in Adult Patients

Clinical Scenario
Hurley Stage III

This protocol targets adult, non-pregnant patients with hidradenitis suppurativa at Hurley Stage III — defined by multiple or extensive interconnected sinuses and significant scarring.

Why This Stage Is Distinct

Hurley staging reflects disease severity and informs treatment intensity. Stage I involves recurrent nodules and abscesses with minimal scarring; Stage II is characterised by one or a limited number of sinuses and scarring within a single body region. Stage III — the stage addressed here — is defined by multiple or extensive sinuses and/or scarring, representing the most severe disease burden and warranting a more intensive systemic approach.

Treatment Approach

Management at this stage centres on systemic therapy, with evidence-based options that include both targeted systemic agents and combination antibiotic regimens. For patients with a suboptimal response to standard treatment, adjunct systemic therapy may also be incorporated.

Full regimen, agent selection, and sequencing available in the complete protocol →
Instant Access to Structured Evidence-Based Regimens

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.
Infliximab is recommended for moderate-to-severe disease; however, dose-ranging studies are needed to determine the optimal dosage for management.
Moxifloxacin, metronidazole, and rifampin in combination are recommended as second- or third-line treatment in moderate-to-severe disease.
Long-term systemic corticosteroids tapered to the lowest possible dose can be considered in cases of severe HS, as an adjunct therapy in patients with suboptimal response to standard therapy.
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