Hidradenitis Suppurativa, GdB and Severe Disability in Germany

For people living or working in Germany. The Grad der Behinderung (GdB) is a German legal concept; this article explains the German framework specifically. It is written in general, plain terms and is not individual legal or social-law advice, and it does not predict a GdB for you. Only the competent German authority decides a GdB, case by case, after reviewing the medical documentation submitted.

Last updated: 5 September 2026.

Hidradenitis suppurativa (HS), also known as acne inversa, can affect much more than the skin. Pain, recurrent drainage, open wounds, surgery, scars and restricted movement can interfere with work, mobility, self-care and everyday participation.

In Germany, long-term health-related limitations can, under certain conditions, be formally recognised through a Grad der Behinderung, usually abbreviated GdB. For HS specifically, there is no automatic GdB. A diagnosis does not by itself produce a particular number, and a Hurley stage cannot simply be converted into a GdB.

The German disability-assessment system asks about the actual, long-term impact of health impairments on participation. Because HS can fluctuate considerably over time, good documentation matters more here than for many other conditions. This guide explains what the current framework says, what may be worth documenting, and how to prepare if you decide to apply.

In 60 seconds

• A GdB describes the extent of long-term participation impairment in Germany.
• It is not a percentage of “how disabled” someone is, and it does not directly measure ability to work.
• A GdB of at least 50 constitutes severe disability under German law.
• People with GdB 30 or 40 may, in some circumstances, apply for Gleichstellung with severely disabled people for employment purposes.
• There is no automatic GdB for HS.
• Current German assessment criteria for skin disease consider factors such as extent, affected body areas, chronicity, recurrence, and accompanying symptoms such as oozing, burning or odour.
• Scars can also matter, when they restrict movement or affect surrounding structures.
• Do not convert your own Hurley stageHurley Stage: A regional, mainly structural classification system for Acne Inversa in one specific body region, in three stages: Stage I (single abscesses without sinus tracts), Stage II (recurrent abscesses with isolated, still-separated sinus tracts), Stage III (extensive, interconnected sinus tracts and scarring across an entire region). Named after Dr. Helen Hurley. Classic Hurley staging is static and isn't designed to reflect short-term inflammatory activity or response to medical treatment — IHS4 is used alongside it for that.Hurley StageA regional, mainly structural classification system for Acne Inversa in one specific body region, in three stages: Stage I (single abscesses without sinus tracts), Stage II (recurrent abscesses with isolated, still-separated sinus tracts), Stage III (extensive, interconnected sinus tracts and scarring across an entire region). Named after Dr. Helen Hurley. Classic Hurley staging is static and isn't designed to reflect short-term inflammatory activity or response to medical treatment — IHS4 is used alongside it for that.Read more in the glossary into a GdB.
• Useful documentation describes concretely what HS actually prevents, restricts or repeatedly requires in daily life.

What is the Grad der Behinderung?

The Grad der Behinderung is the German administrative measure describing how strongly one or more long-term health impairments restrict participation in society. Under German law (Section 2(1) SGB IX), a disability is a health-related impairment that is highly likely to last longer than six months and that affects participation.

Recognised degrees of disability run in steps of ten from 20 to 100 (Section 152(1) SGB IX); the medical assessment standards behind that scale sit in the annex to the Versorgungsmedizin-Verordnung (Medical Assessment Ordinance).

A GdB is not the same as:

• a percentage of health loss,
• a percentage of inability to work,
• disease severity alone,
• an entitlement to a specific benefit.

The underlying question is broader: how strongly, and how persistently, do the health impairments affect participation in everyday life — not only at work, but across life domains?

When does someone count as severely disabled in Germany?

A GdB of at least 50 meets the legal definition of severe disability (Section 2(2) SGB IX), provided the additional residence/stay requirements are also met. From GdB 50, a Schwerbehindertenausweis (severe-disability card) can be applied for through the competent authority (Section 152 SGB IX).

That is different from GdB 30 or 40.

What is Gleichstellung?

Someone with a GdB of 30 or 40 can, under certain conditions, apply to the Bundesagentur für Arbeit (Federal Employment Agency) to be treated similarly to a severely disabled person for employment purposes. The central conditions for this — a GdB of at least 30 but under 50, and that the disability makes it harder to obtain or retain a suitable job without that status — are set out in Section 2(3) SGB IX. That provision also imports the remaining requirements of Section 2(2) SGB IX: the applicant must lawfully have their residence, habitual abode, or qualifying employment in Germany. Section 151 SGB IX separately governs the scope of application and the procedural mechanics of Gleichstellung.

Gleichstellung can bring certain employment-related protections, such as special dismissal protection and access to support from the Integrationsämter (integration offices). It is not identical to every provision that applies to formally recognised severe disability — check with the Bundesagentur für Arbeit which specific provisions apply before relying on any particular entitlement.

Gleichstellung is not automatic. It must be applied for separately.

Does hidradenitis suppurativa automatically qualify for a GdB?

No.

There is no rule stating “HS diagnosis = GdB X.” There is also no valid conversion table such as:

Hurley stage	GdB
I	10
II	30
III	50

Do not use a table like this. It does not exist officially, and it misrepresents what the assessment actually asks.

Hurley staging describes structural features of the disease — the number and extent of abscessesAbscess: An inflamed cavity or swelling containing pus or fluid. In hidradenitis suppurativa, abscesses can form as part of the inflammatory disease process and do not automatically mean that a bacterial infection is present. Secondary bacterial infection can occur and may require separate medical assessment. In Acne Inversa, abscesses occur mainly in the armpits, groin, and other skin folds.AbscessAn inflamed cavity or swelling containing pus or fluid. In hidradenitis suppurativa, abscesses can form as part of the inflammatory disease process and do not automatically mean that a bacterial infection is present. Secondary bacterial infection can occur and may require separate medical assessment. In Acne Inversa, abscesses occur mainly in the armpits, groin, and other skin folds.Read more in the glossary, tunnelsSinus Tract: A tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.Sinus TractA tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.Read more in the glossary and scarring. GdB assesses long-term participation impairment under a different standard. The two can be related, because more extensive disease more often comes with greater restriction — but they are not interchangeable.

What does the current German regulation say about skin disease?

The Versorgungsmedizin-Verordnung sets out general principles for assessing skin disease. Relevant factors include:

• the type of skin disease,
• its extent,
• the body areas affected,
• effects on general health,
• accompanying symptoms,
• tendency to recur,
• chronicity,
• repeated need for inpatient treatment.

As examples of relevant accompanying symptoms, the regulation names itchingPruritus (Itch): Itch. Often overlooked in Acne Inversa because pain dominates, but a significant minority of patients rate itch as the most distressing symptom, particularly during the healing phase of lesions.Pruritus (Itch)Itch. Often overlooked in Acne Inversa because pain dominates, but a significant minority of patients rate itch as the most distressing symptom, particularly during the healing phase of lesions.Read more in the glossary, oozing, burning, and unpleasant or socially disturbing odour. That list is strikingly relevant to HS, since drainage, recurrent inflammation and odour can make up a substantial part of the disease burden.

The regulation also allows strongly fluctuating skin disease to be assessed on the basis of its average course rather than a single point in time. For HS, that is one more reason a longer symptom history can be more informative than a single appointment during a relatively quiet week.

A note on currency: the exact wording, section numbering, and the orientation values it uses are amended from time to time. Always check the official source for the currently applicable text rather than relying only on a summary — on this site or anywhere else.

Why doesn’t the table simply say “hidradenitis suppurativa”?

The regulation’s skin-disease table still uses older terminology in several places. Section 17.3 includes Acne conglobataAcne Conglobata: A severe, scarring form of nodulocystic acne, usually on the back, chest, and buttocks. Shares mechanistic and immunological overlap with Acne Inversa.Acne ConglobataA severe, scarring form of nodulocystic acne, usually on the back, chest, and buttocks. Shares mechanistic and immunological overlap with Acne Inversa.Read more in the glossary and particularly severe forms that the text historically describes as “Acne triade” and “Acne tetrade” — terms from before the name hidradenitis suppurativa / acne inversa became standard. The orientation values there are tiered: lower values for limited, localised abscess and fistulaFistula: A specific kind of tunnel that connects an inflammatory cavity to the skin surface, allowing chronic drainage. In HS literature, 'draining tunnel' and 'fistula' are often used interchangeably.FistulaA specific kind of tunnel that connects an inflammatory cavity to the skin surface, allowing chronic drainage. In HS literature, 'draining tunnel' and 'fistula' are often used interchangeably.Read more in the glossary formation, and higher values — up to well above 50 — for the most severe, recurrent, scarring forms affecting the armpits, groin and neck.

Read these orientation values cautiously.

They are not an automatic promise that a particular person with a particular clinical picture will receive a particular GdB. The regulation itself describes such figures as orientation values, where the circumstances of the individual case are taken into account.

The careful conclusion is: the regulation contains skin-disease patterns that overlap substantially with severe HS — but the competent authority still assesses the individual’s actual impairments, not just the label in the table.

What aspects of HS may be worth documenting?

The most useful documentation is concrete. Rather than writing only “my HS is severe,” describe what actually happens.

1. Body areas affected

Record which areas are or have been affected: armpits, groin, genital or perianal area, buttocks, under the breasts, abdominal folds, and any other sites. Location matters, because the same disease burden can have very different functional consequences depending on where it occurs — an axillary scar may limit arm movement, a gluteal lesion may make sitting difficult, groin disease may affect walking.

2. Recurrence and chronicity

Record how often inflammatory episodes occur, whether the same areas repeatedly reactivate, how long individual episodes last, and whether symptom-free periods genuinely exist or whether drainage persists between obvious flaresFlare: A period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.FlareA period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.Read more in the glossary.

3. Pain

Document more than a pain score — document what the pain changes. “Pain in my left groin prevented normal walking for four days, and I could not use public transport to get to work” gives something concrete to review; “pain 7 out of 10” alone gives less.

4. Drainage and wound care

Record practical consequences: number of dressing changes, clothes becoming wet, need for extra wound-care supplies, needing access to a private space, waking at night for dressing changes.

5. Odour

This is uncomfortable to document, but it may be relevant — the regulation specifically names unpleasant odour as a possible factor in assessing skin disease.

6. Movement restrictions

Examples: difficulty walking, sitting, raising an arm, bending, climbing stairs, driving, cycling, or sleeping in a normal position.

7. Scars

Scars can matter beyond appearance. The regulation names scars as their own assessment factor, depending among other things on extent, characteristics, scar contractureContracture: A scar that tightens and physically restricts movement — for example, an armpit scar limiting how far the arm can be raised. A known complication of extensive Acne Inversa or extensive HS surgery.ContractureA scar that tightens and physically restricts movement — for example, an armpit scar limiting how far the arm can be raised. A known complication of extensive Acne Inversa or extensive HS surgery.Read more in the glossary, location, and effect on surrounding structures. “The scar tissue in my armpit prevents me from fully raising my right arm” is more concrete than “I have large scars.” Our guide to HS scars covers this in more depth.

8. Surgery and inpatient treatment

Keep operation reports, dischargeDischarge / Exudate: Fluid coming from an Acne Inversa lesion or tunnel. Can be clear (serous), bloody (sanguineous), pus-like (purulent), or a mix.Discharge / ExudateFluid coming from an Acne Inversa lesion or tunnel. Can be clear (serous), bloody (sanguineous), pus-like (purulent), or a mix.Read more in the glossary letters, and wound-care documentation. Repeated need for inpatient treatment is an explicitly named assessment factor.

9. Treatment burden

Also potentially relevant: long-term treatment, frequent appointments, repeated procedures, and side effects that are themselves a meaningful burden.

10. Work effects

Examples: medical leave, leaving shifts early, restricted sitting or standing, extra breaks for dressing changes, difficulty with required clothing.

Our work-impact record was built specifically to capture working days like these concretely — no account needed, stored only in your browser.

HS can substantially affect work — but averages do not set your GdB

A German multicentre study found that HS was associated with meaningful work-related burden for a substantial share of participants, and with work-ability and productivity scores that, on average, were noticeably lower than the general working population.

Findings like these are population averages. They do not tell you what GdB a particular person should receive. Your own application needs to describe your own long-term impairment — not study averages.

What if I have several health conditions?

The overall GdB is not obtained by simply adding up individual values. For example:

GdB 30 for HS + GdB 30 for depression does not automatically add up to an overall GdB of 60.

The Versorgungsmedizin-Verordnung instead calls for an overall assessment of how the individual impairments interact and overlap. Some impairments affect the same area of life and do not simply add on top of each other; others increase the overall burden across different functional areas. The competent authority makes the final overall assessment.

Is a GdB the same as being unable to work?

No. These are different questions.

GdB describes long-term participation impairment.

Arbeitsunfähigkeit (incapacity for work) concerns whether you are currently able to perform your specific job for health reasons.

Erwerbsminderung (reduced earning capacity) is a separate concept from German pension-insurance law, concerned with remaining capacity to work under that system’s own standards.

A person can therefore:

• have a high GdB and still work,
• be temporarily unable to work without having a high GdB,
• have GdB 30 or 40 and seek Gleichstellung for employment reasons.

Do not treat these terms as interchangeable.

How do I apply?

The responsible authority depends on where you live — depending on the federal state, it may be called the Versorgungsamt, Landesamt, Sozialamt, or another designated body. The authority reviews the medical documentation submitted and issues a Feststellungsbescheid (determination notice) stating the recognised GdB and any additional markers.

A personal examination is not required in every case — many decisions rest substantially on the documents and medical findings submitted. Current, complete and concrete documentation is therefore important.

A practical preparation checklist

Before applying, check whether you can answer these questions clearly.

Disease course

• When was HS diagnosed?
• How long did symptoms exist before diagnosis?
• Which body regions have been affected?
• How often does the disease recur?
• Are there persistent tunnels or draining areas?

Treatment

• Which medical treatments have been used?
• Have procedures or surgery been required?
• Have there been hospital admissions?
• Is ongoing wound care necessary?

Symptoms

• How often is pain present?
• How often does drainage occur?
• Is odour a recurring issue?
• Do you experience sleep disruption or fatigue related to HS?

Function

• Is sitting limited?
• Is walking limited?
• Is arm movement limited?
• Are dressing changes needed outside the home?
• Does required clothing or protective equipment create problems?
• Are household activities restricted?

Participation

• Are work or education repeatedly interrupted?
• Are social activities avoided because of drainage, pain, or wound care?
• Does travel become more difficult?
• Is intimacy affected?
• Is help from another person required?

Other diagnoses

• Are there separately diagnosed physical or mental-health conditions that also affect participation?

Do not answer these questions to make your situation sound worse than it is. The purpose is to avoid reducing a complex, fluctuating disease to one sentence: “patient has hidradenitis suppurativa.”

Three common mistakes

Mistake 1: Submitting only the diagnosis. A diagnosis confirms the disease. It does not describe its full functional consequences.

Mistake 2: Submitting only your worst photographs. Photographs can document skin appearance. They typically do not show frequency, pain, movement restriction, wound-care burden, surgery, work impact, or chronicity.

Mistake 3: Trying to calculate your own GdB. Published orientation values are part of an overall assessment. They are not a self-scoring questionnaire. Use them to understand the framework — not to assign yourself a number.

What if I disagree with the decision?

The Feststellungsbescheid contains information about legal remedies and deadlines. If you believe relevant impairments or evidence were not considered, independent advice may help.

Possible routes:

• Ergänzende unabhängige Teilhabeberatung (EUTB) — free, independent counselling,
• disability advocacy organisations (Sozialverbände),
• disability advice services,
• specialist legal advice where needed.

Our full directory of official German support routes — including GdB, Gleichstellung, occupational integration management, and the EUTB — is at Official support routes in Germany.

Questions to discuss with your dermatologist

• Does my medical record clearly describe how often HS recurs for me?
• Are all currently affected body areas documented?
• Are persistent tunnels and drainage documented?
• Is movement restriction caused by scars recorded?
• Are previous HS operations and hospital treatments listed?
• Is my ongoing wound-care burden documented?
• Are relevant comorbiditiesComorbidity: An additional condition existing alongside the primary disease. Acne Inversa is frequently associated with comorbidities including metabolic syndrome, inflammatory bowel disease, spondyloarthritis, and depression.ComorbidityAn additional condition existing alongside the primary disease. Acne Inversa is frequently associated with comorbidities including metabolic syndrome, inflammatory bowel disease, spondyloarthritis, and depression.Read more in the glossary documented separately?
• Would a short summary of my functional limitations make the record clearer?

Your dermatologist does not determine the GdB. But accurate medical documentation can make your disease course easier for the competent authority to understand.

The bottom line

There is no fixed GdB for hidradenitis suppurativa. The German system does not simply convert diagnosis → stage → number. It assesses long-term participation impairment. For HS, current criteria make factors such as recurrence, chronicity, location, drainage, odour, scars, treatment burden and functional restriction particularly relevant.

The most useful preparation is therefore not trying to prove that HS is “severe enough.” It is building a clear record of what happens, how often it happens, what remains between flares, and what those problems prevent or require in everyday life.

If cost coverage, biologicsBiologic: A class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.BiologicA class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.Read more in the glossary, or rehabilitation claims are also part of your current situation, our guide to health insurance coverage for hidradenitis suppurativa covers those claims directly.