Power Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions

Caposiena, Raffaele Dante; Solivetti, F. M.; Bianchi, Luca

doi:10.1111/jdv.14745

Cited by 31 publications

(40 citation statements)

References 14 publications

(27 reference statements)

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“…This difference could be related to longer healing time and higher risk of relapse for draining tunnels compared with nodules and abscesses. In this study, ultrasonographic evaluation played an important role in defining and characterize each lesion to monitor more precisely the response to the treatment, as reported in several previous studies . Interestingly, inflammatory lesions also showed an overlapping decrease after some time, possibly because of the anti‐inflammatory effect of anti‐TNF‐α.…”

Section: Discussionmentioning

confidence: 62%

“…Patients were examined clinically and with power Doppler ultrasonography (MyLabOne ultrasonograph; Esaote, Genova, Italy) using a 10–18 MHz linear transducer at all symptomatic sites every 12 weeks for a total period of 108 weeks. Lesions were categorized according to their power Doppler morphology to classify their type (nodule, abscess or draining tunnel) and to identify inflammatory and noninflammatory lesions, which respectively produced or did not produce a signal on power Doppler …”

Section: Methodsmentioning

confidence: 99%

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Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab

et al. 2019

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Background. Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, skin disease. adalimumab is the sole approved drug for the treatment of HS, but it only partially controls the symptoms. Aim. To evaluate the incidence of flares during 108 weeks of therapy and the clinical response to adalimumab. Methods. In total, 20 patients with moderate-severe HS treated with adalimumab were included to evaluate the number of flares, mean time interval between flares, lesion count number of patients who reached the Hidradenitis Suppurativa Clinical Response (HiSCR) of ≥ 50% reduction in inflammatory lesion count, and the International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (VAS) and Dermatology Life Quality Index (DLQI). Results. In total, 90% of patients reported at least 1 flare, and in total 48 flares were counted for the whole group; mean time between flares was 26.9 AE 16.4 weeks. Duration between flares was 30.5 AE 16.3 and 12.5 AE 5.7, respectively, in responders and nonresponders. A progressive decline in flares was observed with treatment, while a gradual increase in the number of patients achieving HiSCR was attained during the observational period. Lesion count, IHS4, pain VAS and DLQI decreased throughout the study. In detail, adalimumab showed a higher efficacy on nodules and abscesses than on draining tunnels. The study was limited by its retrospective nature and small number of patients. Conclusion. Adalimumab is an effective and safe treatment for patients with HS despite the high number of flares.

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Section: Discussionmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab

et al. 2019

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“…Vascularization was assessed semiqualitatively according to a four‐category scoring system previously reported : 0 = absence of vascularization; 1 = minimal vascular spots; 2 = moderate vascularization; 3 = detectable vascular flow (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…Nevertheless, these scores do not take into account vascularization of nodules, abscesses, and fistulous tracts, which can be instead assessed by means of Color Doppler. Vascularization, which is strictly related to local inflammation, has only rarely been evaluated in sonographic reports on HS …”

Section: Introductionmentioning

confidence: 99%

Color Doppler as a tool for correlating vascularization and pain in hidradenitis suppurativa lesions

et al. 2019

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Background Hidradenitis suppurativa (HS) is a debilitating, chronic‐relapsing, inflammatory skin disease of apocrine gland‐bearing skin, presenting with nodules, abscesses, and fistulae. Ultrasound is used to classify HS lesions but evaluation of vascularization, related to tissue inflammation, needs Color Doppler. The aim was to correlate vascularization of HS lesions with patients’ reported pain. Methods Vascularization was assessed with Hitachi Arietta V‐70 sonographer according to a four‐category system ranging from absent (0), minimal (1), moderate (2) vascularization, and detectable vascular flow (3). Pain was scored with Numeric Rating Scale (NRS) from 0 to 10. Results Twenty‐four patients were included, 13 men (54.2%) and 11 women with mean age of 37.2 (range: 19‐61 years). Sixty‐nine HS lesions were studied: none of the lesions with absence of vascularization was painful. Lesions with minimal vascularization had a mean NRS value of 3.1 (range: 0 to 7; standard deviation [SD]: 1.6). Lesions with moderate vascularization had a mean NRS value of 6.4 (range: 4‐8; SD: 1.4). Lesions with intense vascular flow had a mean NRS value of 7.8 (range: 5‐9; SD: 1.7). Correlation Spearman's rank coefficient calculated between the class of vascularization and the mean NRS value was 0.98, supporting high correlation between intensity of vascularization and local pain. Conclusion The present study is the first one demonstrating correlation between vascularization of HS lesions assessed with Color Doppler and local pain. Color Doppler may be a dynamic diagnostic tool that can address the therapeutic approach and assess response to treatment in HS.

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“…US is also useful in treatment monitoring and follow‐up with the first sign of treatment response being represented by the decrease of inflammatory activity at colour Doppler. Other US signs of disease improvement include reduction/disappearance of fluid collections and fistulous tracts, and the likely presence of residual scarring appearing as epidermal and dermal parallel hyperechoic areas .…”

Section: Ultrasound In Hidradenitis Suppurativamentioning

confidence: 99%

Ultrasonography in the pathway to an optimal standard of care of hidradenitis suppurativa: the Italian Ultrasound Working Group experience

Lacarrubba

Dini

Napolitano

et al. 2019

Acad Dermatol Venereol

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Background Ultrasound (US) is a real‐time non‐invasive technique that has been demonstrated to support an early diagnosis and a more precise assessment of hidradenitis suppurativa (HS). Objectives To compare the clinical and US evaluation of a series of HS patients. Methods 434 HS patients (259 F, 175 M; mean age 33.82 ±13.31 years) observed across 19 Italian dermatology centres [members of the Italian Ultrasound Working Group (IUWG)] were enrolled in a retrospective study. Clinical staging was obtained by the Hidradenitis Suppurativa Physician's Global Assessment score (HS‐PGA), while the ultrasonographic staging was determined by the US HS‐PGA, based on the same scores as clinical HS‐PGA but performed with the aid of US. Results At the end of the study, the mean clinical and US HS‐PGA scores were 2.70 and 2.92, respectively. Direct comparison of clinical and ultrasonographic assessment revealed that a higher proportion of patients was classified as having moderate and very severe disease by US. In particular, 117 patients (26.96%) had a worse classification by US HS‐PGA compared to clinical assessment. Conclusion Our findings confirm that the use of clinical grading only to assess HS severity may underestimate the real disease severity. US examination can be considered an essential non‐invasive imaging tool available to dermatologists for a more accurate diagnosis, staging, treatment planning and monitoring of HS and should be included in the pathway to an optimal standard of care of HS.

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Power Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions

Abstract: Vascular distribution of HS lesions can be evaluated by PD with additional relevant information for earlier and better disease management.

Cited by 31 publications

References 14 publications

Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab

Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab

Color Doppler as a tool for correlating vascularization and pain in hidradenitis suppurativa lesions

Ultrasonography in the pathway to an optimal standard of care of hidradenitis suppurativa: the Italian Ultrasound Working Group experience

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