Hidradenitis Suppurativa - Images of Stages

Because hidradenitis suppurativa (HS) is often mistaken for an infection, a long delay in diagnosis is not uncommon.1 Dermatologists typically assess the signs and symptoms of HS on a scale - these categories are developed from a clinical measure of severity called the Hurley scale:1,2

Hurley stage I

Single or a few isolated boils without sinus tracts (narrow channels that form under the skin and break out on the surface) or scarring.1-3

  • These tender bumps generally start as firm, pea-sized nodules. Since they typically are red, the nodules are often mistaken for acne or an ingrown hair.2,4,5

Hurley stage ll

Recurring boils in single or multiple areas with scarring and sinus tracts.1,2

  • Recurs frequently leaving scars with normal skin in between.6,7

Hurley stage lll

Widespread boils with multiple interconnected tracts across the affected area.1,2

  • Multiple boils and scars with no normal skin left between them.7
  • May be associated with an unpleasant smelling discharge.2,8


  1. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012;366:158–164.
  2. Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2009;23:985–998.
  3. http://www.nhs.uk/conditions/hidradenitis-suppurativa/Pages/Introduction.aspx. Accessed April 2021.
  4. NHS Choices. Hidradenitis suppurativa. Available at: http://www.nhs.uk/conditions/hidradenitis-suppurativa/Pages/Introduction.aspx. Accessed April 2021.
  5. Genetics Home Reference. Hidradenitis suppurativa. U.S. National Library of Medicine. Available at: https://medlineplus.gov/genetics/condition/hidradenitis-suppurativa/. Accessed April 2021.
  6. Collier F, Smith R, Morton C. Diagnosis and management of hidradenitis suppurativa. BMJ 2013;346:f2121.
  7. Gill L, Williams M, Hamzavi I. Update on hidradenitis suppurativa: connecting the tracts. F1000Prime Rep 2014;6:112.
  8. Dufour ND, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgrad Med J 2014;90:216–221.


AU-HUM-210055 August 2022.