Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory, disabling skin disease, which primarily involves the hair follicles. HS mainly affects people aged from 18 to 44, and the prevalence remains uncertain, from 0.03% to 8%. 1,2 The first pathogenetic step is follicular keratin plugging, followed by the rupture of the follicular wall and dermal foreign body-type inflammatory response. 3 Activation of the autoinflammatory/inflammasome pathway leads to the formation of typical lesions. 4,5 Diagnosis requires the presence of typical recalcitrant lesions, such as nodules, abscesses, tunnels, tombstone comedones, and scars localized in the typical areas of the apocrine glands: axillary, inguinal, genitofemoral, gluteal, perineal, and inframammary. 4,6 The mean diagnostic delay is seven years which has a strong impact on the patient's quality of life. 4 Several clinical scores have been used to evaluate the severity of

Background High‐frequency ultrasound (HFUS) is a non‐invasive method that detects superficial skin features. Ultra‐high frequencies (50‐100 MHz) can reveal epidermis and dermis structures. Objectives In this study, we describe the psoriatic plaque using a new device equipped with a 70 MHz probe (VEVO® MD, Fujifilm, VisualSonics) and we assess the lesion before and after ixekizumab. Methods We examined the superficial hyperechoic band, the subepidermal hypoechoic band (SLEB), and the vascularization of the plaque in ten patients affected by plaque psoriasis. Results The average superficial hyperechoic band thickness was 0.2157 mm before treatment, 0.1611 mm after 15 days, and 0.1354 mm (P < .05) after 30 days. The SLEB thickness was 0.7535 mm at baseline, 0.3300 mm after 15 days (P < .05), and 0.2007 mm (P < .05) after 30 days. The average percentage vascularization was 50.21% at baseline, 13.15% after 15 days (P < .05), and 5.97% after 30 days. UHFUS assessment highlighted the rapid action of the drug in terms of the decrease in vascularization after 15 days. It revealed a statistically significant reduction in SLEB thickness after 15 days and a significant reduction in the hyperechoic superficial band after 30 days. Conclusions VEVO® MD provides physicians with high‐resolution details of the psoriatic plaque, thus enabling tailored‐made treatments.

The management of hidradenitis suppurativa (HS) flares with intralesional steroids lacks strong scientific evidence but limited data suggest that it may be useful. The objective of this study is to assess the clinical and ultrasound responses of HS flares to ultrasound‐guided injections of intralesional triamcinolone (40 mg/ml) with a dilution 1:4 versus 1:2 at 30‐day (t1), 60‐day (t2), and 90‐day (t3) follow‐up. We recruited patients with ≤3 acute lesions, unresponsive to topical therapy. At baseline we assessed lesions clinically and by ultra‐high frequency ultrasound (48 or 70 MHz) and randomly performed an ultrasound‐guided injection of triamcinolone. Assessments were repeated at t1, t2, and t3 follow‐up, re‐injecting the lesion in the case of no or partial response. We treated 49 lesions: 38.8% showed improvements at t1; 46.9% at t2; 6% at t3; and 8.3% showed no clinical and ultrasound improvements. Long‐term follow‐up data confirmed a statistically significant reduction in Visual Analogue Scale (VAS)‐pain, Dermatology Life Quality Index (DLQI), and HS‐Physician Global Assessment (HS‐PGA), as well as edema and vascular signals. No adverse effects were reported. Our study suggests that ultrasound‐injections with a 1:2 dilution are beneficial for HS flares that do not respond to topical treatment and should be included in the therapeutic algorithm.