Staging the Disease

Treatment of any disease should be graduated to reflect disease intensity. For HS this means that staging according to Hurley's criteria is beneficial and should be done prior to therapy (see Table 25.1). It is however important to realize that disease evolution in individual patients is not simply linear, and that the stages imply different needs and therapeutic opportunities because of the predominant features of each stage, e.g., scarring in Stage III (see Fig. 25.1). Of all patients, it is estimated that as many as 75% remain in Hurley Stage I, 24% progress to Hurley Stage II and only a small minority progress further. In addition to the staging of the disease it is mandatory to obtain information about the frequency of flares before the start of therapy. The use of the lesional score of Sartorius (see Chap. 3) and the counting up of the number of painful days and of the intensity of pain may be very helpful for that purpose.

Table 25.1. Hurley's criteria for staging hidradenitis sup-purativa (HS)

Stage I:

Abscess formation, single or multiple, without sinus tracts and cicatrization

Stage II:

Recurrent abscesses with tract formation and cicatrization

Single or multiple, widely separated lesions Stage III:

Diffuse or near-diffuse involvement, or multiple interconnected tracts and abscesses across the entire area

Fig. 25.1. Prevalence and strategies for therapy

The goal of treatment is to reduce the extent and progression of the disease so as to bring the 25 patient back to a milder stage (see Fig. 25.1).

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