This protocol applies to adult patients with hidradenitis suppurativa who have progressed to Hurley stage III — the most severe disease stage, defined by multiple or extensive interconnected sinus tracts and significant scarring. The patient is not pregnant.
Hurley staging classifies hidradenitis suppurativa by anatomical extent and structural damage. Stage III represents the most advanced presentation: multiple or extensive sinuses and/or scarring, distinguishing it from stage I (recurrent nodules and abscesses with minimal scar) and stage II (a limited number of sinuses and/or scarring within a body region).
At Hurley stage III, management may involve rescue parenteral antibiotic therapy — used as a bridge to surgery or for severe refractory disease — alongside immunomodulatory options and, where appropriate, surgical excision of extensive chronic lesions. The specific agents, selection criteria, and treatment sequencing are laid out in the full structured 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.
IV ertapenem is recommended for severe disease as a 1-time rescue therapy or as a bridge to surgery or other long-term maintenance.
Wide local scalpel, CO2, or electrosurgical excision (with or without reconstruction) is appropriate for extensive chronic lesions.
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