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. References Collier, F., Smith, R. C., & Morton, C. A. (2013). Diagnosis and management of hidradenitis suppurativa. BMJ: British Medical Journal , 346 (7905), 29–32. http://www.jstor.org/stable/23494597

Recent studies suggest that people living with Hidradenitis Suppurativa (HS) are more likely to experience depression and anxiety. Here are three constructive ways to support your mental health while living with HS. Image, Pexels, May 7, 2025 Recent studies suggest that patients battling Hidradenitis Suppurativa are more likely to experience depression and anxiety. Medical Exhaustion HS is a chronic, painful condition with recurring flare-ups. There is no cure for HS, only ways to manage the disease. Many patients go through years, and for many, their entire lives of trial-and-error treatments, surgeries, or misdiagnoses, leading to frustration and burnout. Constant dermatology appointments, pre-op preparations, and post-op care can sometimes feel exhausting and all-consuming. Social Isolation HS affects 1/100 people, meaning the prevalence of this condition is around 1% (Collier Et Al., 2013, p.29). Due to this small percentage, HS is considered to be a "rare disease." Many in the HS community celebrate with 300 million others on Feb.28 to raise awareness for HS on National Rare Disease Day. Because we are a small percentage, often feelings of social isolation can take over. Unfortunately, there is not enough public and medical awareness as to what HS is, which leads to many misdiagnoses and a lack of general understanding. People with HS may withdraw from social or romantic relationships, increasing feelings of loneliness. Low Self-Esteem and Body Image Issues Unlike other inflammatory conditions that share the same category as HS, such as Crohn's disease, HS is often physically visible. HS attacks areas that skin rubs on skin, which includes intimate parts of the body. HS can cause scarring and drainage, both of which can impact a patient's self-esteem or can contribute to body image issues. Validated quality of life tools show worse scores for pain, effects on social functioning, living activities, and self-image in hidradenitis than in psoriasis and eczema (Collier Et Al., 2013, p.29). Here are three constructive ways to improve mental health when battling HS. Journaling Writing regularly can help patients process their emotions, track flare-up patterns and reflect on progress. Try combining symptom tracking with personal reflections to best understand the link between physical and mental health. "The act of journaling becomes a form of self-therapy that assists with personal growth and development, intuition and self-expression, problem solving, stress reduction, health benefits, reflection and critical thinking" (Portman et al., 2020, p.597). Joining a Support Group Whether virtually or in person, HS-specific support groups offer a safe space to connect with others who truly understand what it's like to live with HS. Support groups offer opportunities to share experiences, reduce feelings of isolation and offer practical tips and emotional encouragement from others. Support groups are a great way to lift each other, share relevant management tips and build a community. Having a sense of community when battling HS can help patients feel better understood."In conceptualizing community, the idea of alienation alerts us to the importance of social connection" (Coburn et al., 2017, p.79). Therapy or Counselling Talking to a therapist—especially one who understands chronic illness—can be invaluable. Therapies such as Cognitive Behavioural Therapy (CBT), for example, can help reframe negative thought patterns into positive ones and manage emotional stress tied to the condition. Professional therapists can provide various other strategies to take care of your mental health. References COBURN, A., & GORMALLY, S. (2017). COMMUNITY . Counterpoints , 483 , 77–92. http://www.jstor.org/stable/45177772 Collier, F., Smith, R. C., & Morton, C. A. (2013). Diagnosis and management of hidradenitis suppurativa . BMJ: British Medical Journal, 346(7905), 29–32. http://www.jstor.org/stable/23494597 Portman, S. (2020). Reflective Journaling: A Portal Into the Virtues of Daily Writing . The Reading Teacher , 73 (5), 597–602. https://www.jstor.org/stable/27003592

Approach your surgery with confidence to ensure a better healing process Surgeon performing surgery, Pexels, Feb. 12, 2024 Undergoing a de-roofing or excision surgery can be a daunting experience. Proper preparation can help ease you're concerns and contribute to a smoother recovery. This article will guide you through key steps to take before your HS surgery. You will better understand the procedure, what to ask during pre-op consultations and how to best preparing your'e home for post-surgery recovery. What is the difference between De-Roofing, Wide Excision and Local Excision Surgery? For a De-roofing surgery a surgeon will target sites of sinuses and tracts (tunnels under the skin caused by HS) and the overlying skin around these areas will be de-roofed, in other words, removed. Local Excision surgery is similar to de-roofing surgery and is a surgery that typically treats patients on the lower hurley stage. During this procedure, the surgeon will remove select areas and abscesses where the disease has attacked. A Wide Excision is when a large area is de-roofed and removed. This is typically a more intensive surgery and the patient is left with a significantly bigger wound. It's important to ask during your consultations leading up to the surgery what type of surgery the surgeon thinks will need to take place. It's good to keep in mind that even the best surgeons who have performed countless HS surgeries may not know how much they need to remove until they are in and actively performing the surgery. Despite that unfortunate reality, well-experienced surgeons will likely be able to estimate what route they believe will be the best way to go about treating you. Arranging Consultations Do not be afraid to request consultations with both your dermatologist team and the surgeon who will be performing the surgery. For local Excisions, I have been in a situation where the surgeon is ready to cut right there and then without prior consultation. I do not advise this. When preparing for your surgery, especially with the understanding that surgeons may not know how wide of an area they will need to remove will have a big impact on how big of an open wound you will be left with post-op and how much time you may need to heal. When going to your consultation appointments be your best advocate and ask as many questions as you need to. Bringing a notepad and pencil to write down notes and or bringing a support person who may also have a list of questions on your behalf is a good idea. Preparing For Surgery Local Excisions can be done while the patient is awake and the area will be frozen. There isn't too much to prepare for this one. The De-Roofing and more particularly the Wide Excision will often mean the patient is put under anesthesia sedation. For this, you will want to prepare better. Make sure you don't eat or drink for at least 24 hours before surgery, often you will be allowed a small glass of water or a small black coffee but confirm with the surgeon before. You will be asked to show up on surgery day with no jewellery or nail polish on. If you have long hair I would bring an elastic so you can put your hair in a bun under the surgical hat. Make sure you have a supportive person who can drive you home and monitor you for 24 hours post-op. Before leaving your house prior to surgery setting up a place to lie down on either a couch or a bed with a bowl is suggested. It's very common for people to be nauseous from the anesthesia accompanied by vomiting is very typical. Most people will feel best in a dark room where they can just rest it off. Once your able to hold food and water down the nausea will subside and you will regain energy. Post-Op Wound Care Post-Op wound care will be a pain. Surgeries for HS now usually leave the wound open for a thicker more flexible scar and ultimately better mobility. Wound care will be vital to arrange. Ask the surgeon in the consultation if they will arrange wound care for you or if that is something you need to do. Healing processes can vary depending on what surgery you got, the health of the wound when healing and the fact that everyone heals at different times. For myself and other friends who have had the Wide Excision surgery, the wound can take up to a year to heal and close. For most Local Excisions depending on how much is taken, I would prepare for 2-3 months. Wound care is typically daily until the nurses believe every other day or three days is appropriate. For someone who feels comfortable a lot of nurses will encourage at home care where you or a loved one changes the dressings on your own. I recommend this, it will save you a lot of time however be confident before to ensure you feel fully comfortable with the regiment. If you plan to travel post-op, you will likely need to contact the coordinator of the nursing company and arrange for your file to be transferred to whatever nursing clinic will take you closer to where you will be. Post- Op Exercises Since you will be left with an open would stretching will be really important. It may feel like it's prolonging the healing especially if the wound keeps ripping open again but it's important to get a thick and flexible scar for better mobility. Tight scaring particularly in crease areas can have long-term effects on your future mobility. I'ts encouraged to try and use it as much as you can as you regularly would. Once your wound is closed and you no longer have dressings on it, you will notice the area is highly sensitive and in many ways more uncomfortable than the open wound. This will subside with time (sometimes a lot of time) and massaging it to desensitize the area will help. The sensitivity is due your your nerves being freshly regenerated during the healing process. This is also why as the wound bed begins to lift and your wound begins to heal the closer to the surface it rises the more painful it will feel. Fresh after post-op expect a deeper throbbing pain and closer to the end prepare for a scrape-tingy sort of pain. Note that it shouldn't scab the way a scrape does it will lift and get smaller and smaller until closed. Emotional Preparation The severity of trauma to the area varies depending on what surgery you get done. For local excision, it can be small little blips but can be bigger blips as well. For bigger surgeries like the Wide Excision prepare for serious trauma in the area especially if the surgeon has de-roofed in a crease for example the crease of your armpit. If the crease has been de-roofed prepare for healing to take longer, stretching to be more painful with occasional rips as well. Wide Excisions can mean your entire underarm is essentially skinned and is all an open wound. This can be a lot psychologically and seeing it on your first wound care appointment will likely be highly uncomfortable. Bringing music to these appointments does help. A journal is a good way of taking care of the emotional aspect when healing and makes a great way to track your regimen as it changes and your healing progress. Support groups are a fantastic way to engage in discussion or questions you may have for others with HS who have potentially gone through the same surgery. HS social media is a great tool. Many HS advocacy pages are ways to find relatable content and even meet people who have HS and have been through similar things as you. Talking It Out Talking with friends or family who are wanting to support you through this can really help. Therapy is also a good option if you feel talking to a professional is needed. Post-Op can be rigorous and there can be some frustrating and low moments in recovery. Making sure your mental health is okay is key.

Join Toronto's community in raising awareness and supporting those affected by Hidradenitis Suppurativa during a week filled with informative events CN Tower, Toronto, May. 29, 2024 The Hidradenitis Suppurativa community will be celebrating HS awareness week from June 3rd to 7th, 2024 in downtown Toronto! Some activities happening in Toronto and close to Toronto include the CN Tower being lit up purple as well as Nathan Philips's iconic Toronto sign! CN Tower Event Details Toronto's annual CN Tower purple illumination event will be held on Thurs. June 6th, 2024 for Hidradenitis Suppurativa. The Tower has been illuminated for many years and has been an exciting event for those in the HS community as well as a meeting spot for HS support groups to meet up, connect and celebrate together! The tower will be periodically illuminated from multi-coloured to solid purple. Nathan Phillips Square Another fantastic event on the same evening as the CN Tower illumination is Nathan Phillips Square's Toronto sign being illuminated purple for HS awareness week as well! Nathan Phillips Square has been another meeting hub for various HS organizations and support groups in the Toronto region. Civic Centre Clock Tower For those closer to Mississauga the well-known Civic Centre Clock Tower will be illuminated purple during the evening on Wed. June 5, 2024, in celebration of HS Awareness Week. City Hall Clock Tower For those closer to Brampton the City Hall Clock Tower will be purple on Mon. June 3, 2024, in support of bringing HS out of the dark. Events Around Canada A part from the greater Toronto area their are lots of other illumination events around Canada that will begin at sunset in support of the exciting week ahead! For folks living near Vancouver British Columbia, the BC Place will be lit purple on Wed. June 5, 2024, the Sails Of Light on Mon. June 3, 2024, the Science World Sphere on Thurs. June 6, 2024, Burrard Street Bridge on Tues. June 11, 2024 and City Hall on Tues. June 11, 2024. For those close to Calgary Alberta events with purple illumination displays include the Calgary Tower on Tues. June 4, 2024 and the reconciliation Bridge on Tues. June 4, 2024. In Montreal, the Olympic Park Tower will be purple on Mon. June 3, 2024, and in the Niagra region the iconic Falls that split Canada and America will be illuminated purple the same night! In Halifax, City Hall will be purple Mon. June 3, 2024, and in St John the Confederation Building on Wed. June 5, 2024, will be lit purple as well! Support Group Events If you are part of an HS support group and would like to get involved in HS awareness week it would be worthwhile contacting the groups' admin to ask if they are planning any events in regions closer to you. Popular events include Walking For HS and barbecue events. Online Access It's good to note that many of the illumination displays will be live-streamed online as well. If you google the building or bridge and click on a live-stream event you are likely to be able to enjoy the show from home if you can't make it.

A close-up photo of a woman on an elliptical, Pixabay, Jan. 2024 Maintaining a healthy weight Maintaining a healthy weight is key to keeping HS under control. Although weight is a contributor to the worsening of HS and is frowned upon and a stigmatized concept, my journey of twelve years proves that it can. My weight has always fluctuated and my relationship with food has always been a vulnerable area for me. In periods where my weight increased, I noticed HS flares in new areas where skin-on-skin contact was never an issue at a lower weight. As my weight would increase I would also notice my food intake was high cards, dairy, and processed foods, which were all triggers that I chose to ignore. I noticed a significant worsening of my physical flare-ups. Weight loss has helped me significantly. However, working out can repel especially with HS. HS is incredibly painful, and since it targets places that have skin-on-skin contact, working during flare-ups can suck. Recommendation My Recommendation is during flare-ups, choose to work out during the flare-up or not if you do expect the flare-up to get worse before it gets better. At the gym, I recommend avoiding machines like the treadmill and sticking to ellipticals. Ellipticals are great because they create space between your legs, avoiding friction and irritation to the flare-up. If your flare-up is in your under the arm, stay away from lifting weights, focus on your legs and cardio until the flare-up gets better. Swimming is also a fantastic way to avoid unnecessary friction if you want a creative cardio workout when flaring. My Hope I hope that although it's painful, stay focused on the goal. Self-care and a healthy lifestyle both hold significant importance when it comes to HS. Be your accessor in regards to your flare before pursuing physical activity, skipping out on your fitness routine is okay and your well-being should always be prioritized.

Author: Sarah Mooallem Date Last Edited: Jan 1, 2023 1:33pm A doctor holding a patients hand, Pixabay, Dec. 19, 2023 HS check up's and vulnerability In regards to HS medical professionals' approach and attitude toward a patient holds significant value. Often HS check-ups and surgical interventions tend to be highly invasive leaving patients feeling vulnerable. HS often attacks areas that rub together resulting in checkups getting quite personal. Frequent Emergency Intervention Denial Many people living with chronic illness occasionally need to take trips to emergency or walk-in clinics for immediate medical intervention. Unfortunately, many medical experts know very little about the condition, resulting in us frequently getting denied when we seek out insition and drainage intervention. Many physicians will justify the denial by either stating they don't want to cause unnecessary scaring or they don't believe it will be helpful. My hope My hope for those living with HS is not to settle. If you experience impatience or hostility,  or you are simply not comfortable with medical professionals' techniques, keep searching and don't give up on finding a doctor you feel comfortable with. Your body is your home and deserves the best. Once you have found a good team, the medical professionals in your circle will be foundational assets and vital members of your support team.

Author: Sarah Mooallem Date Last Edited: Jan 1, 2023 1:33pm Medical injection needle, Pixababy Dec. 19, 2023 What are TNF inhibiter biologic injections, and what do they do? Tumour necrosis factor, better known as TNF inhibitors is a biological medicine used to help control inflammation. These biologics are often used to treat autoimmune diseases such as hidradenitis suppurativa, rheumatoid arthritis, psoriasis, and Crohn's disease. "Once they're put into your blood, they cause a reaction in your immune system that blocks inflammation"(WebMD, Dec. 6, 2022.) How do TNF suppressors help hidradenitis suppurativa ? People who suffer from Hidradenitis Suppurativa have a higher level of TNF-Alpha in the body which causes the often uncontrollable inflammation during flare ups. For HS patients our levels of TNF are typically much higher then then should be which is why we flare the way we do. TNF prohibiters are used to suppress that over the top inflammation. Do TNF prohibitors compromise your immune system? People who suffer from Hidradenitis Suppurativa have a higher level of TNF-Alpha in the body which causes often uncontrollable inflammation during flare-ups. For HS patients our levels of TNF are typically much higher than they should be which is why we flare the way we do. TNF prohibiters are used to suppress that over-the-top inflammation. My experience with TNF biologic injections I have been on a TNF prohibitor called Hadlima for close to three years now. When I first sat down with my dermatologist I was opposed to resorting to injections and it took me years to accept. I was hoping for a more natural and less daunting way to deal with my HS. After years passed by and my HS progressively got worse, I realized that HS is a highly aggressive skin disease. I came to the unfortunate realization that natural remedies simply won't be enough to see progress and I would have to fight fire with fire and consider a more aggressive treatment in hopes of a reduction of flare-ups. Unfortunately, the TNF prohibitor I have been on hasn't been all that effective and I have recently been considering taking part in a drug trial in hopes of finding a medicine with a higher effective rate percentile called izokibep. It is common for TNF prohibiters to either help HS patients or not be effective, and it boils down to what medicine combos work for each individual. My Hope I hope that if you or a loved one is considering TNF prohibiters to help combat HS you are matched with an effective medicine that works well with you. I also hope that with the new wave of research being poured into hidradenitis suppurativa through drug trials new TNF prohibitions with higher success rates get FDA approved to create public access.