Hidradenitis Suppurativa Scoring Systems

Scoring systems are used in medicine to facilitate the comparison of one individual to another, and to evaluate effects of therapies. Hidradenitis Suppurativa is especially challenging because of the wide variability in patient manifestations. A consistent system is desirable however, and would be especially important in the goal to align treatment according to specific patient findings.

The oldest, and simplest system is the Hurley staging system.

• Stage I is a single lesion without sinus tract formation.
• Stage II manifests as more than one lesion or area, but with limited tunneling.
• Stage III is defined as multiple lesions, with more extensive sinus tracts and scarring.

The Sartorius system is an additional method for quantitating the severity of HS/AI. This system also relies on physical findings, and allows calculation of a numerical score for each body area involved. Points are awarded for:

• Involvement in specific body areas (3 points each body area)
• Nodules (2 points for each)
• Fistulas (4 points)
• Scars (1 point)
• Other findings (1 point)
• Longest distance between two lesions (2-4 points)
• If lesions are separated by normal skin (yes-0 points; No-6 points)

Some evaluators have assigned additional value to the presence of pain, drainage, or odor (referred to as the Modified Sartorius system). Also, some scoring designs have considered the parameter of frequency of flares.

Recently, Physician Global Assessment (PGA) and Patient Global Assessment (also PGA) have become useful tools to evaluate patient severity as well as responses to therapy. Other grading systems are under consideration. Ideally, a globally-accepted scoring system, incorporating Objective findings, Subjective features, and Functional capabilities is needed. International collaboration is currently in progress to further refine the systems already in use. This information was originally published by the HS-foundation.