Understanding Hurley's Classification

Sarah Mooallem
May 7, 2025
2 min read

Understand Your HS Diagnosis: A breakdown of Hurley's classification diagnostic system for Hidradenitis Suppurativa

Hurley's Classification Diagram, HSDisease.com, Oct. 2021

HS is frequently diagnosed by medical professionals using Hurley's classification system. When diagnosed, a patient will be diagnosed with Hurley stage 1, 2 or 3. Patients are diagnosed by the severity of the disease's progression.

Hurley Stage 1

Being diagnosed with Hurley stage 1 means you were diagnosed early into the progression of the disease, or your HS is less severe. To be diagnosed with Hurley stage 1, a medical professional would need to find at least one abscess formation, single or multiple, without sinus tracts or scarring (Collier Et Al., 2013, p. 31). This means that physical lesions are apparent however, the disease has not progressed to attached tunnelling below the surface of the skin.

Hurley Stage 2

Being diagnosed with Hurley stage 2 means you were diagnosed at a point where the disease has evolved enough for sinus tracts under the skin to be apparent. To be diagnosed with Hurley stage 2, a medical professional would need to find recurrent abscesses with sinus tracts and scarring, single or multiple widely spread lesions (Collier Et Al., 2013, p. 31). This means that a minimum of one lesion has reocurred in the same spot, scarring is evident, and the disease has formed a sinus tract tunnel underneath the skin's surface, attaching from at least one lesion to another. HS can form sinus tracts underneath the skin with multiple routes, meaning more than two lesions can be connected. However, this is a characteristic more frequently correlated with Hurley stage 3.

Hurley Stage 3

Being diagnosed with Hurley Stage 3 means you were diagnosed at a point where your disease had more time to evolve. This could mean you were diagnosed later on, have been misdiagnosed in the past or have a more severe case. To be diagnosed with Hurley stage 3, a medical professional would need to find diffuse or almost diffuse involvement or multiple interconnected tracts and abscesses (Collier Et Al., 2013, p. 31). This means a medical professional has assessed that multiple tracts of tunnels have developed underneath the skin's surface, attaching more then to more than two lesions.

It's important to note that there are only three stages in the Hurley classification diagnostic system. Medical professionals will provide different management options depending on the Hurley stage a patient has been diagnosed.

For Hurley stage 1, dermatologists may suggest lifestyle changes such as weight, smoking habits and various diets that eliminate common triggers for HS. Topical medications may also be prescribed to be applied to HS lesions.

For Hurley stage 2, dermatologists may treat the disease with various prescribed topical medications, oral medications, and may suggest non-aggressive treatments such as laser hair removal and suggest de-roofing surgeries.

For Hurley Stage 3, dermatologists may treat the disease with topical, oral, laser hair removal, biologic injections such as Humira or Hadlima, low-impact de-roofing surgeries and high-impact local and wide excision surgeries.

Hidradenitis Suppurativa has no cure; all the measures listed above are ways to try and manage the disease, not to cure the disease.