Hidradenitis suppurativa (HS) affects apocrine-bearing skin. The HURLEY staging system classifies HS into three grades. A patient with multiple interconnected sinus tracts and scarring diffusely throughout the axilla without clear areas of normal skin would be classified as:

• A Hurley Stage I
• B Hurley Stage II
• C Hurley Stage III ✓
• D Modified Sartorius score category 1

Explanation

Hurley Stage III is characterised by diffuse, widespread involvement with multiple interconnected sinus tracts, abscesses and extensive scarring, leaving no clear normal skin in the affected region. Hurley Stage I shows isolated abscess formation without sinus tracts or scarring. Stage II features recurrent abscesses with sinus tracts and scarring but with normal skin interspersed. HS is driven by follicular occlusion, not primary apocrine infection; adalimumab (anti-TNF) is the only biologic approved specifically for HS.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.