Topic 1: Moderate HS Is Not Defined by Appearance Alone

Determining whether HS is mild, moderate, or severe is not always straightforward, and recognizing moderate disease is crucially important for guiding therapy to gain disease control and prevent long-term sequalae. Two patients with a similar number of visible lesions may have very different levels of inflammatory activity, accumulated tissue damage, pain, flare frequency, and functional impairment.¹

There is also no single universally accepted definition of moderate HS. Different staging systems and outcome measures evaluate different aspects of the disease and may classify the same patient differently. A comprehensive assessment should consider:²

• Inflammatory activity: current nodules, abscesses, and draining tunnels
• Structural damage: tunnels, scarring, tissue distortion, and restricted movement
• Patient-reported burden: pain, drainage, odor, flare frequency, emotional distress, and interference with daily activities

Current guidance supports combining objective examination findings with the patient’s symptoms and lived experience when evaluating severity and treatment response.³