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Denofre ATDAS, Stecca CM, Serrano JYM, Buffo TH, Dertkigil RP, Magalhães RF. Doppler ultrasound protocol for patients with hidradenitis suppurativa. An Bras Dermatol 2024; 99:670-679. [PMID: 38851892 DOI: 10.1016/j.abd.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. OBJECTIVE To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. METHODS A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. RESULTS Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. STUDY LIMITATIONS The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. CONCLUSIONS The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life.
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Affiliation(s)
| | - Carolina Meloni Stecca
- Discipline of Dermatology, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Thais Helena Buffo
- Discipline of Dermatology, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Rachel Polo Dertkigil
- Discipline of Radiology, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Renata Ferreira Magalhães
- Discipline of Dermatology, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
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2
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Wortsman X. Role of Color Doppler Ultrasound in Cutaneous Inflammatory Conditions. Semin Ultrasound CT MR 2024; 45:264-286. [PMID: 38056784 DOI: 10.1053/j.sult.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Inflammatory cutaneous diseases can be challenging to diagnose and manage. Nowadays, the anatomical information provided by ultrasound is critical for detecting subclinical alterations and assessing the severity and activity of these conditions. Many of these entities can be clinically observed in dermatology and other specialties, such as rheumatology, plastic surgery, ophthalmology, and otolaryngology, among others. We review the ultrasonographic patterns of the most common inflammatory cutaneous conditions. In several cases, such as hidradenitis suppurativa, acne, and morphea, there are ultrasonographic staging systems of severity or activity that are pivotal in the management of these diseases. The early ultrasonographic diagnosis of these entities implies a proper management of the patients and, therefore, improve their quality of life. Thus, knowledge of the current use of ultrasound in this field seems essential.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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3
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Nazzaro G, Calzari P, Vaienti S, Passoni E, Marzano AV. The role of imaging technologies in the diagnosis of hidradenitis suppurativa. Clin Dermatol 2023; 41:611-621. [PMID: 37652192 DOI: 10.1016/j.clindermatol.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Hidradenitis suppurativa is a chronic, inflammatory, recurrent, and debilitating disease of the hair follicle. It presents with painful, deep-seated, inflamed lesions, such as nodules, abscesses, sinus tracts, and fistulas, generally located in the main folds. Clinical severity assessment alone can be reductive; noninvasive skin imaging technologies, such as ultrasound, magnetic resonance imaging, medical infrared thermography, computed tomography, and positron emission tomography, provide subclinical anatomical and functional details. These instrumental techniques confirm the clinical suspect, thus allowing an earlier diagnosis and improving patients' clinical evaluation, staging, and management. Finally, they might be helpful for preoperative mapping. In this contribution, we provide an overview of the current knowledge about noninvasive skin imaging techniques with a particular focus on ultrasonography, which is widely used thanks to its precision, versatility, and availability.
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Affiliation(s)
- Gianluca Nazzaro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Dermatology Unit, Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Paolo Calzari
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvia Vaienti
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuela Passoni
- Dermatology Unit, Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Dermatology Unit, Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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4
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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5
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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Recurrence Rates Following Reconstruction Strategies After Wide Excision of Hidradenitis Suppurativa: A Systematic Review and Meta-analysis. Dermatol Surg 2021; 47:e106-e110. [PMID: 33795566 DOI: 10.1097/dss.0000000000002815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurrent hidradenitis suppurativa. When performed, excision is followed by decisions regarding best options for management of the surgical defect. Different reconstructive strategies (RSs) have been used, with varying rates of recurrence. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different RS after WE and their recurrence rates. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,813 retrieved articles, 79 were included in the analysis. Most were retrospective analyses, with only one randomized controlled trial (RCT) and 7 prospective analyses. The RS described were divided into primary closure (PC), secondary intention healing (SIH), skin graft (SG), and fasciocutaneous flaps (FCF). The average estimated recurrence for PC was 22.0% (95% confidence interval [CI], 8.0%-40.0%), for SIH 11.0% (95% CI, 5.0%-20.0%), for SG 2.0% (95% CI, 0.0%-5.0%), and for FCF 2.0% (95% CI, 1.0%-5.0%) (p < .001). Hidradenitis suppurativa below the umbilicus was significantly associated with overall recurrence (p = .006). Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION After WE, PC has the highest recurrence rates, whereas SG and FCF have the lowest rates. There is a need for more RCTs and guidelines, to be able to report uniformly on treatment outcomes.
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Anduquia-Garay F, Rodríguez-Gutiérrez MM, Poveda-Castillo IT, Valdes-Moreno PL, Agudelo-Rios DA, Benavides-Moreno JS, Lozada-Martínez ID, Bolaño-Romero MP, Borraez-Segura B, Rahman S. Hidradenitis suppurativa: Basic considerations for its approach: A narrative review. Ann Med Surg (Lond) 2021; 68:102679. [PMID: 34401142 PMCID: PMC8353381 DOI: 10.1016/j.amsu.2021.102679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
Hidradenitis suppurativa is a chronic and debilitating skin disease, whose lesions can range from inflammatory nodules to abscesses and fistulas in the armpits, groin, perineum, inframammary region. Diagnosis can be confused with a large number of clinical pictures, and although studies on hidradenitis suppurativa are not so scarce in the literature, doctors are often unaware of this disease and therefore its diagnosis is often late. Pharmacological treatment ranges from retinoids to immunosuppression and radiation therapy, and surgical treatment ranges from incision and drainage to more complete excisions and laser therapies. Hidradenitis suppurativa is a disease seen and treated mainly by dermatologists and general surgeons, however, it is necessary for general practitioners to have basic knowledge about this entity, as they are the first line of care in the health system. Hidradenitis suppurativa is an entity of necessary recognition by the surgeon. It is a preventable and treatable condition with a good prognosis. This condition should be managed by a multidisciplinary team.
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Affiliation(s)
- Felipe Anduquia-Garay
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- School of Medicine, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - María Manuela Rodríguez-Gutiérrez
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Medical and Surgical Research Center, School of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Colombia
| | | | | | | | | | - Ivan David Lozada-Martínez
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia
| | | | | | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
- Corresponding author.
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8
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Gutfilen-Schlesinger G, Lopes de Souza SA, Gutfilen B. Should We Scan Hidradenitis Suppurativa Patients? A Systematic Review of Radiologic Findings. Adv Skin Wound Care 2021; 34:1-10. [PMID: 34125731 DOI: 10.1097/01.asw.0000753196.64470.6a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To bring awareness and close gaps between dermatologists and radiologists about the contribution of imaging techniques for diagnosis, treatment, and follow-up of hidradenitis suppurativa (HS). DATA SOURCES Investigators searched the PubMed database for articles on HS and radiology techniques. STUDY SELECTION Databases were searched up to December 2018. The query retrieved 257 publications, of which 103 were unique; of these, 7 were inaccessible. From the remaining 96, 33 were irrelevant (did not discuss HS lesion features). After applying the inclusion criteria, 63 studies were relevant to this study. DATA EXTRACTION A standardized form was constructed to extract data from eligible studies by two independent authors. DATA SYNTHESIS Imaging techniques are significant and useful tools in HS management. Imaging should be carried out to evaluate disease severity, subclinical features, treatment success, and intraoperative patient assessment. Providers should consider nonconventional radiology techniques, which are underused in clinical management of HS. Further, dermatology and radiology require a shared terminology of disease features to better understand patient status. CONCLUSIONS Publications on HS lesion imaging have increased over the years. Imaging techniques have proven useful for determining HS severity and treatment effectiveness, as well as intraoperative patient assessment. These authors strongly recommend the use of these techniques in routine clinical practice for patients with HS.
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Affiliation(s)
- Gabriel Gutfilen-Schlesinger
- At the Universidade Federal do Rio de Janeiro, Brazil, Gabriel Gutfilen-Schlesinger, MSc, is PhD Student, Postgraduate Program of Medicine; Sergio Augusto Lopes de Souza, PhD, is Associate Professor, Department of Radiology; and Bianca Gutfilen, PhD, is Full Professor, Department of Radiology. Acknowledgments: The authors thank José Marcos Telles da Cunha, MD, PhD, for his thoughtful insights during various stages of manuscript preparation. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (Finance Code 001) and the Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro. The authors have disclosed no other financial relationships related to this article. Submitted October 23, 2020; accepted in revised form January 7, 2021
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9
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Vergilio MM, Monteiro E Silva SA, Jales RM, Leonardi GR. High-frequency ultrasound as a scientific tool for skin imaging analysis. Exp Dermatol 2021; 30:897-910. [PMID: 33905589 DOI: 10.1111/exd.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 01/07/2023]
Abstract
Ultrasonic imaging is one of the most important diagnostic tools in clinical medicine due to its cost, availability and good correlation with pathological results. High-frequency ultrasound (HFUS) is a technique used in skin science that has been little explored, especially in comparison with other sites and imaging techniques. HFUS shows real-time images of the skin layers, appendages and skin lesions in vivo and can significantly contribute to advances in skin science. This review summarizes the potential applications of HFUS in dermatology and cosmetology, with a focus on quantitative tools that can be used to assess various skin conditions. Our findings showed that HFUS imaging is a reproducible and powerful tool for the diagnosis, clinical management and therapy monitoring of skin conditions. It is also a helpful tool for assessing the performance of dermatological products. This technique may eventually become essential for evaluating the performance of dermatological and cosmetic products.
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Affiliation(s)
- Mariane Massufero Vergilio
- Graduate Program in Internal Medicine, School of Medical Sciences - University of Campinas (UNICAMP), Campinas, Brazil
| | - Silas Arandas Monteiro E Silva
- Graduate Program in Pharmaceutical Sciences, School of Pharmaceutical Sciences - University of Campinas (UNICAMP), Campinas, Brazil
| | - Rodrigo Menezes Jales
- Radiology Service of the Women´s Hospital "Prof. Dr. José Aristodemo Pinotti", Department of Gynecology and Obstetrics of School of Medical Sciences of Campinas State University (UNICAMP), São Paulo, Brazil
| | - Gislaine Ricci Leonardi
- Graduate Program in Internal Medicine, School of Medical Sciences - University of Campinas (UNICAMP), Campinas, Brazil.,Graduate Program in Pharmaceutical Sciences, School of Pharmaceutical Sciences - University of Campinas (UNICAMP), Campinas, Brazil
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10
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Weigelt MA, Hilerowicz Y, Leichter JA, Lev-Tov H. Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound. Dermatology 2021; 237:378-382. [PMID: 33684921 DOI: 10.1159/000513920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. OBJECTIVES To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. METHODS The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. RESULTS All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. CONCLUSIONS We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.
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Affiliation(s)
- Maximillian A Weigelt
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA,
| | - Yuval Hilerowicz
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Jeffrey A Leichter
- UHealth Interventional Radiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
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11
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Almuhanna N, Wortsman X, Wohlmuth-Wieser I, Kinoshita-Ise M, Alhusayen R. Overview of Ultrasound Imaging Applications in Dermatology. J Cutan Med Surg 2021; 25:521-529. [PMID: 33682489 PMCID: PMC8474315 DOI: 10.1177/1203475421999326] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Complete visualization of lesions is critical for the accurate diagnosis and
management of dermatological diseases. Currently, the most readily available
technologies used by dermatologists include dermoscopy and photography.
Nevertheless, ultrasound has emerged as a useful non-invasive modality in
dermatology, which can be added to the clinical examination supporting an early
and more accurate diagnosis. Moreover, there are significant technological
advances in recent years, such as the development of handheld devices and
ultra-high frequency probes that have expanded the integration of ultrasound
into daily dermatology practice. In this article, we reviewed the most common
applications of ultrasound in the field of dermatology.
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Affiliation(s)
- Nouf Almuhanna
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ximena Wortsman
- 14655 Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile.,38103 Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Iris Wohlmuth-Wieser
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Raed Alhusayen
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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12
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Alfageme F, Wortsman X, Catalano O, Roustan G, Crisan M, Crisan D, Gaitini DE, Cerezo E, Badea R. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:39-47. [PMID: 32380567 DOI: 10.1055/a-1161-8872] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dermatologic ultrasound is a recent application of ultrasound for the evaluation of healthy skin and appendages and their diseases. Although the scientific literature regarding this application is still not sufficient for evidence-based guidelines, general recommendations issued by scientific societies are necessary. The EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) steering committee for dermatologic ultrasound has developed a series of consensus position statements regarding the main fields of dermatologic ultrasound (technical requirement, normal skin and appendages, inflammatory skin diseases, tumoral skin diseases, aesthetic dermatology and practice-training requirements). This document is the foundation for future evidence-based recommendations and guidelines for dermatologic ultrasound practice.
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Affiliation(s)
- Fernando Alfageme
- Dermatology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
| | - Ximena Wortsman
- Department of Dermatology, Universidad de Chile, Santiago de Chile
| | | | - Gaston Roustan
- Dermatology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
| | - Maria Crisan
- Dermatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Diana Crisan
- Dermatology, Universitätsklinikum Ulm Klinik für Dermatologie und Allergologie, Ulm, Germany
| | | | | | - Radu Badea
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy, "Iuliu Hatieganu", Cluj-Napoca, Romania
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13
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Caposiena Caro RD, Molinelli E, Brisigotti V, Offidani A, Bianchi L. Lymecycline vs. clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasonography evaluation. Clin Exp Dermatol 2020; 46:96-102. [PMID: 32683727 DOI: 10.1111/ced.14388] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antibiotic therapy remains the first-line treatment for hidradenitis suppurativa (HS). However, literature data on its comparative clinical efficacy and safety are limited. AIM To investigate the efficacy of tetracycline (lymecycline 300 mg daily) vs. the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) by evaluating and comparing the clinical response at the end of antibiotic treatment (10 weeks). METHODS The study retrospectively analysed 52 patients divided in two groups of 26 patients: Group A received lymecycline and Group B received clindamycin plus rifampicin for 10 weeks. Subjects had mild, moderate and severe HS. The clinical and ultrasonography extent of disease was measured by the Hurley Score, Sonographic Score of Hidradenitis Suppurativa, International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (pain VAS) and Dermatology Life Quality Index (DLQI). The primary outcome was the clinical response at the end of the antibiotic treatment period, according to the Hidradenitis Suppurativa Clinical Response measure. RESULTS Both groups showed a significant improvement in IHS4, pain VAS and DLQI from baseline, but this was more marked in Group A. Reductions in nodule counts were similar between the two groups, whereas the number of abscesses and draining tunnels decreased more in Group B. Disease-free survival was similar between the two groups. CONCLUSION Lymecycline monotherapy and clindamycin plus rifampicin combination are both effective treatments for patients with moderate-severe HS. Nodular-type HS seems to respond better to lymecycline, whereas the abscess/tunnel type seems to respond better to clindamycin plus rifampicin.
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Affiliation(s)
- R D Caposiena Caro
- Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - E Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - V Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - L Bianchi
- Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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14
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Salvador-Rodríguez L, Arias-Santiago S, Molina-Leyva A. Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa. Sci Rep 2020; 10:13363. [PMID: 32770058 PMCID: PMC7414138 DOI: 10.1038/s41598-020-70176-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Corticosteroid infiltrations of lesions in hidradenitis suppurativa (HS) appear to be beneficial to acute flares. The aim of this study is to evaluate the effectiveness and safety of ultrasound-assisted intralesional corticosteroid infiltrations to HS lesions. Prospective cohort study between February 2017 and February 2019 on patients with mild to severe HS and one or more inflammatory lesions. The study intervention was ultrasound-assisted intralesional infiltration of triamcinolone acetonide 40 mg/ml. The main outcome was the complete response rate of infiltrated lesions versus non-infiltrated lesions. Two hundred and forty-seven infiltrated inflammatory lesions and 172 non-infiltrated lesions were included. At week 12, 81.1% (30/37) of nodules, 72.0% (108/150) of abscesses and 53.33% (32/60) of draining fistulas presented complete response versus 69.1% (47/68), 54.3% (38/70) and 35.3% (12/34) respectively for the non-infiltrated lesions. The Hurley stage negatively correlated with complete response for abscesses and draining fistulas at - 0.17 (SD 0.06) p < 0.01 and - 0.30 (SD 0.13) p < 0.02 respectively. Ultrasound-assisted corticosteroid infiltration is a useful technique for the treatment of inflammatory HS lesions, with high and sustained response rates, especially for abscesses and small to medium-size simple draining fistulas. The likelihood of response correlates negatively with the Hurley stage.
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Affiliation(s)
- Luis Salvador-Rodríguez
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain
- Instituto de Investigación Sanitaria IBS Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain.
- Instituto de Investigación Sanitaria IBS Granada, Granada, Spain.
| | - Alejandro Molina-Leyva
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
- Instituto de Investigación Sanitaria IBS Granada, Granada, Spain
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15
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Nguyen T, Damiani G, Orenstein L, Hamzavi I, Jemec G. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol 2020; 35:50-61. [DOI: 10.1111/jdv.16677] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T.V. Nguyen
- Bellevue Dermatology Clinic & Clinical Research Center Bellevue WA USA
| | - G. Damiani
- Department of Dermatology Emory University School of Medicine Atlanta GA USA
| | - L.A.V. Orenstein
- Dipartimento di Fisiopatologia Medico‐Chirurgica e dei Trapianti Università degli Studi di Milano Unità Operativa di Dermatologia IRCCS Fondazione Ca' GrandaOspedale Maggiore Policlinico Milano Italy
| | - I. Hamzavi
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - G.B. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
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16
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Nazzaro G, Passoni E, Veraldi S, Marzano AV. Lymph node involvement in hidradenitis suppurativa: Ultrasound and color Doppler study of 85 patients. Skin Res Technol 2020; 26:960-962. [PMID: 32585058 DOI: 10.1111/srt.12896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Gianluca Nazzaro
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Passoni
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Veraldi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | - Angelo V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
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17
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Wortsman X, Calderon P, Castro A. 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. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:845-857. [PMID: 31705709 DOI: 10.1002/jum.15164] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To test the capability of 70-MHz ultrasound for detecting initial ultrasound signs of hidradenitis suppurativa (HS) linked to severity. METHODS A cross-sectional study of the ultrasound images of patients with HS was conducted and compared with a healthy control group. Detection and identification of early subclinical ultrasound signs in the lesional and perilesional areas of the HS cases in comparison with the control group were performed. Statistical analyses included mean, dispersion measures, the Kruskal-Wallis test, and bivariate and multivariate ordered logistic regression studies. Significance was assessed at P < .05. RESULTS A total of 139 patients with HS met the criteria and showed abnormalities of the hair follicles such as a curved shape, ballooning, and protrusion into pseudocysts, collections, or tunnels (donor of keratin sign). Significant increases in the sizes of the hair follicles and hair shafts were found in HS cases. The following ultrasound signs were significantly linked to severity: a connecting band between the base of adjacent hair follicles (bridge sign), a fragment of the hair shaft extruding through a dilated hair follicle (sword sign), and retained cylindrical fragments of keratin in the dermis. Two patterns of fragmentation of the keratin were detected: multifragment and cylindrical. CONCLUSIONS Ultrasound can detect early HS signs that are significantly linked to severity and 2 types of fragmentation of the keratin, which could support the generation and perpetuation of the fluid collections and tunnels. These ultrasound signs can help prompt diagnosis and management, the development and testing of medications, and the measure of treatment outcomes in HS.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Perla Calderon
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ariel Castro
- Office for Clinical Research Support, Hospital Clinico Universidad de Chile, Universidad de Chile, Santiago, Chile
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18
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Martorell A, Jfri A, Koster S, Gomez‐Palencia P, Solera M, Alfaro‐Rubio A, Hueso L, Sanz‐Motilva V. Defining hidradenitis suppurativa phenotypes based on the elementary lesion pattern: results of a prospective study. J Eur Acad Dermatol Venereol 2020; 34:1309-1318. [DOI: 10.1111/jdv.16183] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/12/2019] [Indexed: 01/01/2023]
Affiliation(s)
- A. Martorell
- Department of Dermatology Hospital de Manises Valencia Spain
| | - A. Jfri
- Department of Dermatology McGill University Montreal Canada
| | - S.B.L. Koster
- Medical student Erasmus MC Rotterdam The Netherlands
| | | | - M. Solera
- Department of Dermatology Hospital de Manises Valencia Spain
| | - A. Alfaro‐Rubio
- Department of Dermatology Hospital de Manises Valencia Spain
| | - L. Hueso
- Department of Dermatology Hospital de Manises Valencia Spain
| | - V. Sanz‐Motilva
- Department of Dermatology Hospital de Manises Valencia Spain
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19
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Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab. Clin Exp Dermatol 2019; 45:438-444. [DOI: 10.1111/ced.14127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 01/03/2023]
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20
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Catalano O, Varelli C, Sbordone C, Corvino A, De Rosa D, Vallone G, Wortsman X. A bump: what to do next? Ultrasound imaging of superficial soft-tissue palpable lesions. J Ultrasound 2019; 23:287-300. [PMID: 31786796 DOI: 10.1007/s40477-019-00415-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023] Open
Abstract
Soft-tissue palpable lesions are common in clinical practice, and ultrasound (US) represents the first imaging option in the evaluation of a patient with a soft-tissue swelling. A full and systematic US assessment is necessary, however. This includes grayscale, color- and power-Doppler, spectral-Doppler, and possibly elastography facilities, as well as a trained operator. Several lesions showing characteristic US features can be diagnosed confidently, without any further work-up, and the high spatial resolution of ultrasound in the superficial layers can be a powerful tool to discriminate their etiologies. Second-level options, to be reserved for indeterminate cases or those suspected malignant at initial ultrasound, include magnetic resonance imaging, percutaneous fine-needle aspiration or biopsy, and surgical-excision biopsy. In this article, we discuss the proper US approach for addressing superficial soft-tissue lesions.
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Affiliation(s)
- Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy.
| | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Carolina Sbordone
- Department of Medicine and Health Science "Vincenzo Tiberio", Molise University, Campobasso, Italy
| | - Antonio Corvino
- Department of Movement and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | - Dario De Rosa
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Gianfranco Vallone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinic, University of Chile and Pontifical Catholic University of Chile, Santiago, Chile
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21
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Elkin K, Daveluy S, Avanaki K. Review of imaging technologies used in Hidradenitis Suppurativa. Skin Res Technol 2019; 26:3-10. [PMID: 31595571 DOI: 10.1111/srt.12772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Until recently, clinical assessment with manual palpation of the HS lesions was the primary means to detect HS lesions and their borders. In the past decade, there has been increased application of imaging technologies to HS patients, and it is reported that manual palpation consistently underestimates HS. Of the technologies, ultrasound (US) imaging has been the most efficacious and well-studied. In the present review, we will discuss the various imaging modalities that aid in detecting, managing, and treating HS. MATERIALS AND METHODS Non-invasive HS imaging technologies including ultrasound (US) imaging, magnetic resonance imaging (MRI), medical infrared thermography (MIT), positron emission topography (PET), and computed tomography (CT) were reviewed and compared through a review of the literature. PubMed, Google, and Google Scholar were utilized. RESULTS Of the 4 HS technologies reviewed, US imaging and MRI are the most established and useful non-invasive modalities utilized in HS patients. However, MIT may have potential to aid in the pre-operative and intra-operative surgical excision of HS lesions. CONCLUSION For imaging HS lesions, US imaging is the most well-characterized and has the greatest range of use, while MRI has a role in severe, anogenital HS lesions. MIT of HS lesions is a novel application and merits attention.
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Affiliation(s)
- Kenneth Elkin
- Wayne State University School of Medicine, Detroit, Michigan
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | - Kamran Avanaki
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Biomedical Engineering, Engineering Faculty, Wayne State University, Detroit, Michigan
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22
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Defining Fistular Patterns in Hidradenitis Suppurativa: Impact on the Management. Dermatol Surg 2019; 45:1237-1244. [DOI: 10.1097/dss.0000000000001916] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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Lacarrubba F, Dini V, Napolitano M, Venturini M, Caposiena Caro D, Molinelli E, Passoni E, Monfrecola G, Argenziano G, Berti E, Bianchi L, Calzavara Pinton P, Cannavò SP, Costanzo A, Donini M, Fabbrocini G, Fierro MT, Micali G, Offidani A, Parodi A, Patrizi A, Pellacani G, Peris K, Pimpinelli N, Potenza C, Romanelli M, Rongioletti F, Solivetti F. Ultrasonography in the pathway to an optimal standard of care of hidradenitis suppurativa: the Italian Ultrasound Working Group experience. J Eur Acad Dermatol Venereol 2019; 33 Suppl 6:10-14. [DOI: 10.1111/jdv.15847] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Affiliation(s)
- F. Lacarrubba
- Dermatology Clinic University of Catania Catania Italy
| | - V. Dini
- Department of Dermatology University of Pisa Pisa Italy
| | - M. Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio University of Molise Campobasso Italy
| | - M. Venturini
- Department of Dermatology University of Brescia Brescia Italy
| | | | - E. Molinelli
- Dermatology Unit Polytechnic Marche University Ancona Italy
| | - E. Passoni
- Dermatology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - G. Monfrecola
- Section of Dermatology University of Naples Federico II Naples Italy
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24
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García-Martínez FJ, Vilarrasa Rull E, Salgado-Boquete L, Martorell A, Pascual JC, Hernández-Martín Á, Silvente C, Ciudad-Blanco C, Andrés Esteban E, Alfageme-Roldán F. Intralesional corticosteroid injection for the treatment of hidradenitis suppurativa: a multicenter retrospective clinical study. J DERMATOL TREAT 2019; 32:286-290. [DOI: 10.1080/09546634.2019.1655524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Francisco Javier García-Martínez
- Dermatology Department, Clínica Universidad de Navarra, Madrid, Spain
- Hidradenitis Suppurativa and Cutaneous Ultrasound Unit, Hospital Universitario del Sureste, Madrid, Spain
| | - Eva Vilarrasa Rull
- Dermatology Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Eva Andrés Esteban
- Preventive Medicine Department, Universidad Jaume I de Castellón, Castellón, Spain
| | - F. Alfageme-Roldán
- Dermatology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
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25
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Elkin K, Daveluy S, Avanaki K(M. Hidradenitis suppurativa: Current understanding, diagnostic and surgical challenges, and developments in ultrasound application. Skin Res Technol 2019; 26:11-19. [DOI: 10.1111/srt.12759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Kenneth Elkin
- Wayne State University School of Medicine Detroit MI USA
| | - Steven Daveluy
- Department of Dermatology Wayne State University School of Medicine Detroit MI USA
| | - Kamran (Mohammad) Avanaki
- Wayne State University School of Medicine Detroit MI USA
- Department of Biomedical Engineering Wayne State University Detroit MI USA
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26
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Posso-De Los Rios CJ, Sarfo A, Ghias M, Alhusayen R, Hamzavi I, Lowes MA, Alavi A. Proceeding report of the third symposium on Hidradenitis Suppurativa advances (SHSA) 2018. Exp Dermatol 2019; 28:769-775. [PMID: 30924968 PMCID: PMC6800012 DOI: 10.1111/exd.13928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/18/2019] [Indexed: 01/11/2023]
Abstract
The 3rd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 12-14 October 2018 at the Women's College Hospital in Toronto, Ontario, Canada. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF) founded in the USA and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This cross-disciplinary meeting with experts from around the world was an opportunity to discuss the most recent advances in the study of hidradenitis suppurativa pathogenesis, epidemiology, classification, scoring systems, radiologic diagnosis, treatment approaches and psychologic assessment. Two special sessions this year were HS as a systemic disease and HS management guidelines. There were focused workshops on wound healing and ultrasound. There were two sessions primarily for patients and their families in the HS School programme: One workshop focused on mindfulness, and the second involved discussion among clinicians and patients about various disease aspects and the latest management. To facilitate networking between clinical and research experts and those early in their career, a mentoring breakfast was held.
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Affiliation(s)
| | - Akua Sarfo
- Department of Dermatology, Pennsylvania State University
College of Medicine, Hershey, PA, USA
| | - Mondana Ghias
- Albert Einstein College of Medicine, Montefiore Medical
Center, Bronx, NY, USA
| | - Raed Alhusayen
- Division of Dermatology, Sunnybrook Research Institute,
Toronto, ON, Canada
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit,
MI, USA
| | | | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University
of Toronto, Toronto, ON, Canada
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27
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Martorell A, Alfageme Roldán F, Vilarrasa Rull E, Ruiz‐Villaverde R, Romaní De Gabriel J, García Martínez F, Vidal Sarro D, Velasco Pastor M, Ciudad Blanco C, Segura Palacios J, Rodríguez Bandera A, Pascual Ramírez J, Sancho Sánchez C, Michelena De Gorosábel N, Wortsman X. Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study. J Eur Acad Dermatol Venereol 2019; 33:2137-2142. [DOI: 10.1111/jdv.15710] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/07/2019] [Indexed: 02/07/2023]
Affiliation(s)
- A. Martorell
- Department of Dermatology Hospital de Manises Valencia Spain
| | | | - E. Vilarrasa Rull
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | | | | | | | - D. Vidal Sarro
- Department of Dermatology Hospital Sant Joan Despi Moises Broggi Barcelona Spain
| | | | - C. Ciudad Blanco
- Department of Dermatology Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | | | - J.C. Pascual Ramírez
- Department of Dermatology Hospital General Universitario de Alicante Alicante Spain
| | | | | | - X. Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Departments of Dermatology Universidad de Chile and Pontificia Universidad Católica de Chile Santiago Chile
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28
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Álvarez P, García-Martínez F, Poveda I, Pascual J. Intralesional Triamcinolone for Fistulous Tracts in Hidradenitis Suppurativa: An Uncontrolled Prospective Trial with Clinical and Ultrasonographic Follow-Up. Dermatology 2019; 236:46-51. [DOI: 10.1159/000499934] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/27/2019] [Indexed: 11/19/2022] Open
Abstract
Background: There is little evidence on the use of intralesional triamcinolone (ILT) for managing fistulous tracts in hidradenitis suppurativa (HS). Objective: To assess the clinical and ultrasound response to ILT for single fistulous lesions in HS patients. Methods: A prospective open-label study was conducted to assess response to ILT (40 mg/mL) for fistulous tracts in HS. Consecutive patients (Hurley II stage exclusively) presenting to our department were recruited from August 2016 to August 2018. They received a single injection of ILT as the sole treatment. Lesions were assessed clinically and by ultrasound at baseline and 90 days. Results: Of the 53 included HS patients with fistulous tracts, 36 (67.9%) were women, 30 (56.6%) were smokers, and 36 (67.9%) were obese or overweight (body mass index ≥25). Median Sartorius score was 9.0 (IQR 9.0–36.0), and median duration of the lesion treated was 6 months (IQR 3.0–12.0). Fistulous tracts were injected with 0.5 mL triamcinolone 40 mg/mL. Seven patients were lost to follow-up. At 90 days, 20 (43.5%) lesions showed clinical and ultrasound resolution, 13 (28.3%) showed only clinical resolution while persisting on ultrasound, and 13 (28.3%) persisted both clinically and on ultrasound. Mean clinical size decreased from 17.0 to 5.1 mm (p < 0.0001), while mean length on ultrasound decreased from 16.0 to 8.6 mm (p < 0.0001). Limitations: Small sample size and no control group. Conclusions: Our study suggests that ILT is beneficial for small fistulous tracts in HS.
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29
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Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: Clinical and ultrasound observations. J Am Acad Dermatol 2019; 80:1314-1321. [DOI: 10.1016/j.jaad.2018.11.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/13/2018] [Accepted: 11/18/2018] [Indexed: 01/18/2023]
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30
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Hidradenitis supurativa: necesidad de un diagnóstico e intervención precoz sobre la enfermedad y sus comorbilidades. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:261. [DOI: 10.1016/j.ad.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
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31
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Roustan G. Hidradenitis Suppurativa: Need for Early Diagnosis and Management of the Disease and Associated Conditions. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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32
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Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, Hirata SH, Ramos AMC. Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:7-19. [PMID: 31166401 PMCID: PMC6544037 DOI: 10.1590/abd1806-4841.20198607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.
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Affiliation(s)
- Renata Ferreira Magalhães
- Discipline of Dermatology, Department of Internal Medicine,
Universidade Estadual de Campinas, Campinas (SP), Brazil
| | | | | | - Roberto Souto
- Dermatology Service, Hospital Universitário Pedro Ernesto,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Daniel Holthausen Nunes
- Dermatology Service, Hospital Universitário, Universidade
Federal de Santa Catarina, Florianópolis (SC), Brazil
| | - Mario Chaves
- Dermatology Service, Hospital Universitário Pedro Ernesto,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | | | - Andrea Machado Coelho Ramos
- Dermatology Service, Hospital de Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
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Zouboulis CC, Nogueira da Costa A, Jemec GBE, Trebing D. Long-Wave Medical Infrared Thermography: A Clinical Biomarker of Inflammation in Hidradenitis Suppurativa/Acne Inversa. Dermatology 2019; 235:144-149. [PMID: 30650424 DOI: 10.1159/000495982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A more reliable classification of skin inflammation and severity of active disease results from ultrasound sonography and the new hidradenitis suppurativa/acne inversa (HS) classification system IHS4. However, an objective assessment of skin inflammation in a continuous mode is still the ultimate goal. Long-wave medical infrared thermography (MIT) may offer a blood flow and temperature differential assessment in inflammatory conditions. OBJECTIVE To evaluate the application of MIT in HS. METHODS Standardized photography of the areas involved or been candidates for HS involvement was performed and MIT pictures were taken simultaneously and superimposed on the photographs of 18 patients (11 female, 7 male, median age 38.75 years [95% confidence interval 28.5 and 51 years], Hurley score I 5.6%, Hurley score II 38.9%, and Hurley score III 55.5%). A modification of the Otsu's method facilitated the automatic lesion segmentation from the background, depicting the inflammation area. Moreover, MIT was administered in real-time mode during radical HS surgery. RESULTS A 1°C temperature difference from a corresponding symmetric body region was indicative of inflammation. MIT figures detected a gradual increase of skin temperature from 33.0°C in healthy skin on average to 35.0-36.6°C at the center of inflamma tory lesions in the axilla and to 35.4-36.9°C at the center of inflammation in the groin area. Real-time MIT assessment enabled the definition of the margins and depth of the surgical intervention during the procedure. CONCLUSION MIT is a promising tool for the detection of inflammation severity in HS lesions and can be used as a clinical biomarker in evaluation studies of medical and surgical HS treatment.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany, .,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany,
| | - André Nogueira da Costa
- Experimental Medicine and Diagnostics, Global Exploratory Development, UCB BioPharma SPRL, Braine-L'Alleud, Belgium
| | - Gregor B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - Dietrich Trebing
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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34
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Nazzaro G, Passoni E, Muratori S, Moltrasio C, Guanziroli E, Barbareschi M, Veraldi S, Marzano AV. Comparison of clinical and sonographic scores in hidradenitis suppurativa and proposal of a novel ultrasound scoring system. Ital J Dermatol Venerol 2018; 156:235-239. [PMID: 30298709 DOI: 10.23736/s2784-8671.18.06196-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory disease that presents with nodules, abscesses and fistulae affecting the apocrine gland-bearing skin. Since few years, ultrasonography is used to better characterize HS skin lesions but comparison between clinical and sonographic scores has been made only in small series of patients. To assess concordance between clinical and sonographic scores in a larger cohort of HS patients. METHODS We conducted a retrospective observational study on 140 HS patients comparing two clinical score systems, Hurley and HS-Physical Global Assessment (PGA), with two ultrasonographic scores, sonographic score of hidradenitis suppurativa (SOS-HS) and ultrasonographic HS-PGA, a novel ultrasound scoring system set up by our group. We used the weighted Cohen's Kappa statistic (k) to evaluate the agreement. RESULTS Agreement between Hurley staging and SOS-HS was found in 61.4% of patients (weighted kappa 0.477), while agreement between clinical and ultrasonography HS-PGA scores was found in 35% of patients (weighted kappa 0.278), both findings suggesting a substantial disagreement. CONCLUSIONS Our study demonstrated a relevant disagreement between clinical and ultrasonography scores. Ultrasonography discovered non-clinically evident HS lesions, notably fistulae. Taken together, the above findings may support the view, previously suggested in expert panel reports, on the higher sensitivity of ultrasonography compared to clinics in HS.
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Affiliation(s)
- Gianluca Nazzaro
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Passoni
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Muratori
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Guanziroli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mauro Barbareschi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Angelo V Marzano
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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35
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Napolitano M, Calzavara-Pinton P, Zanca A, Bianchi L, Caposiena Caro R, Offidani A, Ganzetti G, Molinelli E, Dini V, Oranges T, Romanelli M, Egan C, Fabbrocini G, Monfrecola G, Lacarrubba F, Musumeci M, Passoni E, Venturini M, Micali G. Comparison of clinical and ultrasound scores in patients with hidradenitis suppurativa: results from an Italian ultrasound working group. J Eur Acad Dermatol Venereol 2018; 33:e84-e87. [DOI: 10.1111/jdv.15235] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Napolitano
- Department of Medicine and Health Sciences; Vincenzo Tiberio; University of Molise; Campobasso Italy
| | | | - A. Zanca
- Department of Dermatology; University of Brescia; Brescia Italy
| | - L. Bianchi
- Department of Dermatology; University of Rome Tor Vergata; Rome Italy
| | | | - A.M. Offidani
- Dermatological Unit; Department of Clinical and Molecular Sciences; Polytechnic Marche University; Ancona Italy
| | - G. Ganzetti
- Dermatological Unit; Department of Clinical and Molecular Sciences; Polytechnic Marche University; Ancona Italy
| | - E. Molinelli
- Dermatological Unit; Department of Clinical and Molecular Sciences; Polytechnic Marche University; Ancona Italy
| | - V. Dini
- Department of Dermatology; University of Pisa; Pisa Italy
| | - T. Oranges
- Department of Dermatology; University of Pisa; Pisa Italy
| | - M. Romanelli
- Department of Dermatology; University of Pisa; Pisa Italy
| | | | - G. Fabbrocini
- Section of Dermatology; Department of Clinical Medicine and Surgery; University of Naples Federico II; Naples Italy
| | - G. Monfrecola
- Section of Dermatology; Department of Clinical Medicine and Surgery; University of Naples Federico II; Naples Italy
| | - F. Lacarrubba
- Dermatology Clinic; University of Catania; Catania Italy
| | - M.L. Musumeci
- Dermatology Clinic; University of Catania; Catania Italy
| | - E. Passoni
- Unit of Dermatology; Fondazione IRCCS Cà Granda; Ospedale Maggiore Policlinico; Milan Italy
- Department of Medical and Surgical Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - M. Venturini
- Department of Dermatology; University of Brescia; Brescia Italy
| | - G. Micali
- Dermatology Clinic; University of Catania; Catania Italy
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36
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van Straalen KR, Schneider-Burrus S, Prens EP. Current and future treatment of hidradenitis suppurativa. Br J Dermatol 2018; 183:e178-e187. [PMID: 29981245 DOI: 10.1111/bjd.16768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 12/13/2022]
Abstract
This scholarly review on the current and future treatment of hidradenitis suppurativa (HS) focuses on medical and surgical treatment options, while novel pipeline drugs are also discussed. Treatment goals are to limit the incidence and duration of flares, reducing inflammation and suppuration, achieving local cure after surgery and, most importantly, to improve the quality of life of patients with HS. The type of medication and/or surgery should be chosen based on the stage of the disease and the degree of inflammation. However, the lack of a simple scoring system and the lack of clear surgical outcome definitions hamper the interpretation of treatment efficacy and the comparison between different treatment strategies. The therapeutic pipeline for HS is gradually expanding, and will probably lead to a broader panel of more effective therapeutic options.
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Affiliation(s)
- K R van Straalen
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - S Schneider-Burrus
- Department of Dermatology, University Hospital Charité, Berlin, Germany.,Centre for Dermatosurgery, Havelklinik, Berlin, Germany
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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37
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Halani S, Foster FS, Breslavets M, Shear NH. Ultrasound and Infrared-Based Imaging Modalities for Diagnosis and Management of Cutaneous Diseases. Front Med (Lausanne) 2018; 5:115. [PMID: 29922650 PMCID: PMC5996893 DOI: 10.3389/fmed.2018.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Non-invasive bedside imaging tools are becoming more prevalent for assessing cutaneous lesions. Ultrasound used at specific frequencies allows us to assess margins of lesions to minimize the extent of the biopsy that is performed and improve cosmetic outcomes. Vascularity, seen on Doppler ultrasound and contrast-enhanced ultrasound, and stiffness, assessed on tissue elastography, can help differentiate between benign and malignant lesions for clinicians to be more judicious in deciding whether to biopsy. Moreover, research has shown the efficacy in using ultrasound in monitoring flares of hidradenitis suppurativa, a disease affecting apocrine gland-rich areas of the body, for which the current gold standard involves examining and scoring inflammatory lesions with the naked eye. Infrared-based modalities have also been on the uptrend to aid in clinical decision-making regarding suspiciousness of lesions. Reflectance confocal microscopy has lateral resolution that is comparable to histopathology and it has been shown to be an appropriate adjunctive tool to dermoscopy, specifically when evaluating melanomas. Optical coherence tomography has utility in determining lesion thickness because of its depth penetration, and spectrophotometric intracutaneous analysis is becoming more popular as a tool that can be used by general practitioners to know when to refer to dermatology regarding worrisome pigmented lesions. Strides have been made to incorporate electrical impedance spectroscopy alongside dermoscopy in decision-making regarding excision, although the evidence for its use in the clincial setting remains inconclusive. This paper reviews the efficacy and drawbacks of these techniques in the field of dermatology and suggests future directions.
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Affiliation(s)
- Sheliza Halani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F Stuart Foster
- Medical Biophysics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Neil H Shear
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dermatology, University of Toronto, Toronto, ON, Canada
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38
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Caposiena Caro R, Solivetti F, Bianchi L. Power Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions. J Eur Acad Dermatol Venereol 2018; 32:1360-1367. [DOI: 10.1111/jdv.14745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- R.D. Caposiena Caro
- Dermatology Department; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - F.M. Solivetti
- Radiodiagnostic Service; Dermatologic Institute San Gallicano; Rome Italy
| | - L. Bianchi
- Dermatology Department; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
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39
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Commentary on Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa. Dermatol Surg 2017; 43:1074-1075. [DOI: 10.1097/dss.0000000000001153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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