Update on Ultrasound Diagnostic Criteria and New Ultrasound Severity and Activity Scorings of Hidradenitis Suppurativa

Abstract

Hidradenitis suppurativa (HS) is a devasting autoimmune cutaneous disease that affects the hair follicles and can clinically present palpable nodules, abscesses, and tunnels (fistulas), usually in the intertriginous regions. It has been widely reported that color Doppler ultrasound can detect subclinical abnormalities and stage the severity of the disease more accurately. Nevertheless, the ultrasound diagnostic criteria were reported with 15 MHz 10 years ago, and now it is possible to detect early anatomical abnormalities in HS using 70 MHz. Thus, an update of the ultrasonographic diagnostic criteria is needed. The most widely used sonographic staging of severity of HS (SOS‐HS) includes the number of affected regions, besides counting the number of key lesions like pseudocysts, fluid collections, and tunnels; however, the total number of affected regions may fit better in an activity scoring. Furthermore, a high number of tunnels or communicated tunnels can complicate the management and may indicate an even more urgent treatment, which should be considered in the severity classification. To date, no hidradenitis scoring of activity has been reported in the literature, making it difficult to track the degree of inflammation under treatment objectively. Therefore, two new scorings are proposed. The first is an updated sonographic scoring of severity called modified SOS‐HS (mSOS‐HS), and the second is an activity ultrasound scoring of HS called US‐HSA. Both staging systems can provide better anatomical information for discriminating the categories and, therefore, selecting more appropriate treatments and supporting research and clinical trials by giving more objective anatomical tools in real‐world settings.

Multiple verrucous squamous cell carcinomas developing on chronic hidradenitis suppurativa lesions—a rare case report from Romania

“…The studied references present mostly ulcerated, nodular, and metastatic clinical forms of SCC developed from HS. Cosman et al (32), present a paper about a verrucous form, mentioning that their case is the second published with this clinical form, like in our case presentation. Also, we did not find any references about the presence of two SCC tumors at the same time in a patient with HS.…”

Ultrasound Pattern of Cutis Verticis Gyrata

“…DFS, also called perifolliculitis abscedens et suffodiens, has been reported as a form of presentation of hidradenitis suppurativa, an autoimmune inflammatory cutaneous disease that affects the hair follicles and the keratin. 11,12 Limitations of this study are the small number of cases and the threshold detection of high-frequency ultrasound, which includes the lesions that measure <0.1 mm, the epidermal-only lesions, and the detection of pigments. 8,13 Neither of these limitations was significant for diagnosing ultrasonographically CVG.…”