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

Abstract

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.

Coexistence of steatocystoma multiplex and hidradenitis suppurativa: Assessment of this unique association by means of ultrasonography and Color Doppler

“…Fistulous tracts were hypoechoic or anechoic dermal and/or hypodermal band‐like structures connected to the base of widened hair follicles, clinically corresponding to fistulas. An intense Color Doppler signal was found within or around inflamed lesions of HS, as previously reported by our group …”

Doppler ultrasound‐based noninvasive biomarkers in hidradenitis suppurativa: evaluation of analytical and clinical validity

“…Additionally, overall measures of disease activity may be influenced by external psychosocial factors, which are not captured via sonographic measurements. 25,26 Therefore, measurement of epidermal thickness and tunnel diameter at only one body site may be of greater utility in the assessment of localized disease activity, although measurement across all disease sites has been reported to produce accurate assessment of general disease activity. 24 This also emphasizes the utility of ultrasound in the selection of biopsy sites, given the high inflammatory activity surrounding tunnels.…”

A Scoping Review of Non-invasive Imaging Modalities in Dermatological Disease: Potential Novel Biomarkers in Hidradenitis Suppurativa

“…(25). Scoring systems have been proposed based upon qualitative sonographic descriptions (27) which correlate with HS disease activity, quality of life and pain scores (28, 29). This can be explained by the fact that visual inspection of HS lesional skin alone often underestimates the true extent of disease (30, 31).…”