Table 3 Hurley Stage by Treatment related to Physical and Biochemical of HS findings to Treatment
Hurley Stage by Treatment-> Physical Finding↓ |
Stage I |
Stage 2 (here combined therapy of agents listed must be considered) |
Stage 3 (here combined therapy of agents listed must be considered) |
Scarring, fibrosis, oval scars |
ILK |
ILK |
surgery, ILK |
Dkin indurations non continuous |
ILK ABC1,ABC2, TA |
ILK, TNFaB, ABC, DAP, IVAB |
ILK,ABC, TNFaB |
Plaque-like indurations, |
ILK ABC1, ABC 2 |
ILK TNFa B, ABC |
ILK, IVAB, TNFaB |
Ropelike scars, |
ILK, ABC1-ABC2 |
ILK, CO2 laser |
ILK, CO2 laser |
Dermal contractures |
ILK ABC1-ABC2 |
ILK, ABC, TNFaB, IVAB |
ILK |
Keloids painful |
ILK, ABC1, ABC2 |
ILK, ABC, IVAB, TAB, OCP, TNFaB, spironolactone |
TNFaB, ABC, ILK, IVAB |
Abscesses superficial & deep, fistula |
incision drainage, ILK, ABC1, AB2, dapsone |
incision drainage, ILK, ABC, DAP, acitretin TNFaB, IVAB, THB |
TNFaB, surgery, ABC as adjunct, ILK, IVAB, cyclosporine, TH |
Inflammatory mediators |
ILK, TNFa, ABC, DAP botulinum toxin |
ILK, TNFaB, aABC, DAP, botulinum toxin, IVIG |
ILK, TNFaB, ABC as adjunct, cyclosporine, botulinum toxin, IVIG |
Edema independent of lympedema |
compression, massage ABC |
compression, massage, ABC, TNFaB, IVAB |
compression, massage, surgery ABC, TNFaB, IVAB, cyclosporine |
Open ulcerations |
Soothing emulsions, Skin barriers, topical antibiotics |
Soothing emulsions, topical clindamycin, topical dapsone, ABC, TNFaB, THB, IVAB |
surgery, soothing emulsions, topical clindamycin, topical dapsone, IVAB, TNaB, CO2 laser |
Chronic sinuses |
Drainage, ILK, marsupialization, ABC |
Marsupialization, IVAB,DAP, surgery, CO2 laser |
surgery, marsupialization, IVAB, CO2 laser, surgery with GCSF |
Subcutaneous honeycombing |
ILK, ABC |
ILK, ABC, surgery |
ILK, ABC, TNFaB, cyclosporine |
Frictional pain/shearing forces |
weight loss, skin barrier devices & topicals |
weight loss, skin barriers topicals, preparations, special bandages |
weight loss, skin barriers, topicals, preparations, |
Follicular occulsion |
isotretinoin, acitretin, acne surgery, ABC1, 1064nm laser |
acitretin, acne surgery, ABC, surgery, isotretinoin if other treatments fail, ABC, TNFaB, 1064nm laser |
acitretin, TNFaB acne surgery, ABC, surgery, 1064 nm laser |
Rupture of follicules |
ILK, ABC1, ABC2, topical clindamycin topical dapsone |
ILK, ABC, surgery, IVAB, TNFaB, DAP |
ILK, ABC, IVAB Topicals, surgery, cyclosporine |
Acne Inversa |
acitretin, , acne surgery, ABC1, ABC2 |
acitretin, acne surgery, ABC, istretinoin if other tx fail |
isotretinoin acitretin, physical acne surgery, 1064 nm laser ery, ABC, TNFaB, IVAB, |
Pyogenic granulomas |
ILK, cyrotherapy, DAP, ABC1, ABC2 |
ILK, cyrotherapy, DAP, ABC,surgery, TNFaB |
ILK, cyrotherapy, dapsone, ABC,srgery, cyclosporine, TNFaB |
Lymphedema |
the use of compression and, at times, lymphatic massage, consults |
the use of compression and, at times, lymphatic massage, vascular surgery or urology consultation |
the use of compression and, at times, lymphatic massage, vascular surgery or urology consultation |
.Lymphangiectasias |
compression and, at times, lymphatic massage. consults |
the use of compression and, at times, lymphatic massage, vascular surgery.OB or urology consultation |
the use of compression and, at times, lymphatic massage. vascular surgery, OB or urology consultation |
HS with menstrual flaring |
OCP, spironolactone, Cyproterone acetate with ethinyloestradiol |
OCP, spironolactone, Cyproterone acetate with ethinyloestradiol |
leuprolide acetate,flutamide,degarelix, gonadotropin-releasing hormone agonist with surgery |
Men in whom hormone might be involved |
THB |
THB |
leuprolide acetate ,flutamide and degarelix, THB |
ILK-Intralesional triamcinolone acetonide (kenalogy® (concentration 1.25mg-10mg /cc) , TNFaB Tumor necrosis alpha blocker, cyro=cryotherapy,ABC1-antibiotic combination clindamycin/rifampin, ABC2 minocycline /rifampin combinations, ABC3-fluoroquinolones, metronidazole and rifampin ABC ABC All antibiotic combinations (including type 1, 2, 3). IVAB= Intravenous antibiotics, OCP =oral contraceptive pills. Any type of surgery will simply be referred to as surgery in this table types of surgery including excision except marsupialization which involves extensive deroofing of sinuses tracts and is often combined with CO2 laser which is mentioned separately., CO2 laser ablation is a technique that destroys tissue, , Laser will also not be extensively discussed in this table. 10-20% resorcinol=RES DAP= Oral Dapsone OB= obstetrics Consults= vascular surgery, OB or urology consultations, topical antibiotics include topical clindamycin and topical dapsone. tx=treatment, Granulocyte-macrophage colony-stimulating factor+GCSF, TH-2 and TH1 5α-reductas blockers = THB, Topical Antibiotic refers to topical dapsone and clindamycin =TA