electronic International Hidradenitis Suppurativa Severity Score System




Assessment of acne inversa severity made easy and quick

eihs4 pdf

Illustrative PDF

(coming soon)

eihs4 pdf or

Original PDF

(coming soon)

What is the eIHS4?

The eIHS4 is the electronic version of the International Hidradenitis Suppurativa Severity Score System (IHS4), a classification system created by Zouboulis et al. to assess the severity of Hidradenitis Suppurativa (HS), also known as acne inversa. This scoring system was developed through Delphi Rounds involving clinical experts on HS and subsequently validated in a prospective study. The IHS4 offers advantages over the widely accepted Hurley Score, particularly in its dynamic evaluation of HS severity. To determine the IHS4 score, one must count nodules, abscesses, and draining fistulas/sinus tracts, making it easily applicable in both research and clinical practice.



Validation of questionnaire

paper version: yes            digital version: no

How to use the eIHS4

The eIHS4 should only be used by healthcare professionals. It assigns points based on the following calculation:


  1. the number of inflammatory nodules multiplied by 1,

  2. plus, the number of abscesses multiplied by 2,

  3. plus, the number of draining tunnels (fistulae/sinuses) multiplied by 4.


Interpreting the scores, a value of 3 or below indicates mild HS, a score ranging from 4 to 10 suggests moderate HS, and a score of 11 or higher indicates severe HS.

ihs4 en

The following versions of the eIHS4 are available

eihs4 pdf

Illustrative PDF

(coming soon)

eihs4 pdf or

Original PDF

(coming soon)

Recommendations and limitations for measuring of the IHS4 in Hidradenitis Suppurativa

The IHS4 scoring system demonstrates enhanced flexibility in comparison to the Hurley Score, enabling it to effectively capture fluctuations in severity between two medical appointments. There are indications from certain researchers that the IHS4 has the potential to become the preferred method for evaluating the severity of HS, potentially surpassing existing standards. However, it is important to note that currently, the IHS4 has not been incorporated into any clinical guidelines. Consequently, when utilizing the IHS4, it is advisable to complement its use with other measures, such as the Hurley Score, to ensure a comprehensive assessment of the condition.


use icon hstools


The eIHS4 is uncomplicated and easy for physicians to use.

calculate icon hstools


As the severity is determined based on just three defined characteristics, the eIHS4 is quick to use.

hand icon hstools


The eIHS4 enables physicians to make informed treatment decisions.

global icon hstools


The eIHS4 is available in different languages. The use of the respective first language reduces language barriers and supports the understanding between physician and patient.

rating icon hstools


By storing values, the eIHS4 allows for easy monitoring of acne inversa.

platform icon hstools


With DermaValue, your eIHS4 is always just a few clicks away. The application is available for PCs, tablets, smartphones, and other devices.

heart icon hstools


Studies have shown the IHS4 to be a reliable and valid measurement instrument for determining the severity of acne inversa.

nature icon hstools


Take care of the environment and save your patient data on the online platform or as PDF files.


Zouboulis, C. C.; Desai, N.; Emtestam, L.; Hunger, R. E.; Ioannides, D.; Juhász, I. et al. (2015): European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. In: Journal of the European Academy of Dermatology and Venereology : JEADV 29 (4), S. 619–644. DOI: 10.1111/jdv.12966 . Zouboulis, C. C.; Tzellos, T.; Kyrgidis, A.; Jemec, G. B. E.; Bechara, F. G.; Giamarellos-Bourboulis, E. J. et al. (2017): Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity. In: The British journal of dermatology 177 (5), S. 1401–1409. DOI: 10.1111/bjd.15748 .


Our other tools