Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study

Abstract

Background It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS). Objective To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management. Methods Cross‐sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared. Results Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P < 0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P < 0.01). Concordance between clinical and ultrasound intra‐rater examination was 22.8% (P < 0.01); intra‐rater and inter‐rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P < 0.01). Limitations The inability to detect lesions that measure ≤0.1 mm or with only epidermal location. Conclusion Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.

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

“…Our results are similar to that obtained by a recent Spanish multicentre study comparing clinical vs. US assessment of Hurley staging system in 143 HS patients . With the aid of US, the staging changed to a more severe stage in 44.7% of patients who were diagnosed as having Hurley stage I through clinical examination.…”

“…US assessment of Hurley staging system in 143 HS patients. 23 With the aid of US, the staging changed to a more severe stage in 44.7% of patients who were diagnosed as having Hurley stage I through clinical examination. In particular, on clinical examinations 26.6% of patients…”

Seventy‐MHz Ultrasound Detection of Early Signs Linked to the Severity, Patterns of Keratin Fragmentation, and Mechanisms of Generation of Collections and Tunnels in Hidradenitis Suppurativa

“…However, according to the literature, the primary lesions detected by ultrasound in HS have been reported to have similar morphologic characteristics in different ethnicities . The study did not compare the performance of the Hurley and SOS systems because of the widely reported underestimation of the severity by the clinical evaluations in HS …”

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound

“…In a multicenter study ultrasound better assessed hidradenitis suppurativa patients than clinical inspection alone, resulting in upstaging of most patients as a consequence of the identification of occult and deep fistulous tracts, previously considered to be part of an inflammatory nodule [55].…”