Comparison of clinical and ultrasound scores in patients with hidradenitis suppurativa: results from an Italian ultrasound working group

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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.

Section: Ultrasound In Hidradenitis Suppurativasupporting

confidence: 59%

“…Based on the preliminary results of the aforementioned study by Napolitano et al ., the IUWG has encouraged and supported the use of US in HS in several Italian centres. Herein, we report the results of the extension of the previous IUWG study.…”

Section: Introductionmentioning

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

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“…With ultrasound assessment, the clinical approach was modified up to 82% in the sample under study, and a wide number of subclinical fistulas were localized . In addition, a new study found that 28.7% of the included patients were in a more severe stage after ultrasound evaluation . These results are in agreement with the findings of our study, in which a change in staging was noted in a high percentage of patients after ultrasound examination.…”

Section: Discussionmentioning

confidence: 99%

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

Martorell

Alfageme

Rull

et al. 2019

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.

“…Ultrasound examination of the cutaneous cysts was compatible with the diagnosis of pilosebaceous cysts and steatocystomas, as confirmed by histopathology of the two excised lesions. Ultrasound of the axillae showed multiple abscesses, with histopathology of one lesion revealing follicular hyperkeratinization with extensive inflammation and destruction of the apocrine glands, confirming the clinical diagnosis of HS . Ultrasound of the sacrococcygeal nodule was evocative for pilonidal cyst.…”

Section: Case Reportmentioning

confidence: 70%

Follicular occlusion tetrad in a male patient with pachyonychia congenita: clinical and genetic analysis

Musumeci

Fiorentini

Bianchi

et al. 2019

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The case of a 24‐year‐old male patient affected by follicular occlusion tetrad (acne conglobata, hidradenitis suppurativa, pilonidal cyst and dissecting cellulitis of the scalp) associated with clinical signs of pachyonychia congenita (PC)‐2 (focal palmoplantar keratoderma, plantar pain, onycodystrophy and multiple cysts) is reported. The diagnosis was supported by genetic analysis that showed heterozygous mutation within the exon 1 of KRT17 gene. This case may reflect different expressions of a phenotypic spectrum induced by a common genetic alteration.