High‐frequency ultrasound as a non‐invasive tool in predicting early hidradenitis suppurativa fistulization in comparison with the Hurley system

Costa, Izelda Maria Carvalho; Pompeu, Camille Bresolin; Mauad, Eduardo Botelho Silva; Costa, Mariana Carvalho da; Lima, Vanessa Guimarães de Freitas; Pompeu, Marcelo Faro; Regattieri, Neysa Aparecida Tinoco

doi:10.1111/srt.12954

Cited by 6 publications

(4 citation statements)

References 5 publications

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“… 27 Recent studies have found ultrasonography may be beneficial in detecting sonographic features that are associated with increased disease activity and pain, such as intense vascularization, and classification of Hurley stage based on ultrasonography may result in upstaging compared to clinical staging alone. 28 - 30 Finally, as this study predominantly focused on HS patients’ experiences with pain, the impact of other symptoms on patients’ QoL, such as pruritus and wound drainage, was not explored in-depth. However, all patients in this study reported experiencing pruritus as a HS symptom and this attribute had the second highest severity rating out of all 22 pain descriptors on the SF-MPQ-2.…”

Section: Discussionmentioning

confidence: 99%

Understanding Hurley Stage III Hidradenitis Suppurativa Patients’ Experiences With Pain: A Cross-Sectional Analysis

Johnston,

Dupuis,

Lam

et al. 2023

J Cutan Med Surg

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Background More than 90% of patients with hidradenitis suppurativa (HS) report that pain interferes with their quality of life (QoL) and pain may have a larger impact on QoL than disease severity alone. Objectives The purpose of this study was to understand the impact of pain on the daily lives of patients with Hurley stage III HS. Methods This was a single-center, prospective cross-sectional study that was conducted at Beacon Dermatology in Calgary, AB. Patients ≥ 18 years old with Hurley stage III HS in at least one area of the body were prospectively invited to participate in this study. The study consisted of survey questions on patients’ demographic information, past medical histories, HS-related pain histories, and previous therapies for pain management. Additionally, patients completed a series of standardized rating scales on their pain and overall QoL. Results Of the 10 patients that participated in the study, 90% (9/10) expressed a desire for more counselling on pain management options. Many patients (8/10, 80%) reported routine use of over-the-counter pain medications and 70% (7/10) used complementary and alternative medicines (CAMs) to manage their pain. Patients’ efficacy ratings of HS treatments in controlling their pain revealed that topical treatments provided minimal or no relief, while surgical interventions had the highest efficacy for reducing pain. Patients’ average worst pain over the preceding 24 hrs was 6.3 +/- 2.5 (2-9) on the Numerical Rating Scale for pain and the mean Dermatology Life Quality Index score was 19.5 +/- 8.2 (5-29). Conclusions Patients with Hurley stage III HS report high levels of daily pain and QoL impairment and many individuals use over-the-counter treatments and CAMs to manage their pain. Physicians involved in the care of HS patients should consider implementing routine counselling on pain management into their clinical practices, especially for patients with severe HS.

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Section: Discussionmentioning

confidence: 99%

Understanding Hurley Stage III Hidradenitis Suppurativa Patients’ Experiences With Pain: A Cross-Sectional Analysis

Johnston,

Dupuis,

Lam

et al. 2023

J Cutan Med Surg

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“…34 These features make UHFUS suitable for the imaging of small structures and lesions localized in the shallower layers of the epithelium and account for the wide application of this technique in dermatology, where it is employed for the diagnosis, treatment, and follow-up of several skin diseases. [48][49][50][51][52][53] To the best of our knowledge, ultrasound techniques, and namely UHFUS, have never been applied to the intraoral evaluation of bullous diseases. However, limitation in the study sample does and has the potential to become a chair-side tool consistently enhancing the clinical evaluation of oral bullous lesions.…”

Section: Discussionmentioning

confidence: 99%

Ultra‐high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study

Izzetti

Nisi

Aringhieri

et al. 2021

Skin Research and Technology

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Objectives: Intraoral ultra-high frequency ultrasound (UHFUS) is an emerging technique in oral medicine, due to its possibility to provide submillimeter resolution imaging of superficial mucosal structures. In this study, the potential role of UHFUS in the diagnosis of oral pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) is assessed. Materials and Methods: Consecutive patients with suspected oral PV or MMP were enrolled. All patients underwent clinical examination, laboratory tests, intraoral UHFUS scan, and biopsy. Histology and direct immunofluorescence were set as benchmark for diagnosis confirmation. The sensitivity and specificity of UHFUS compared to histology were assessed. Mann-Whitney test was performed to evaluate the presence of differences in the echogenicity of PV and MMP. P-value was set at P < 0.05.Results: Twenty-five patients were included. Thirteen patients were diagnosed with PV, and twelve with MMP. The UHFUS features of PV and MMP lesions were described. Image analysis showed statistically significant differences between the echogenicity of PV and MMP lesions (P < 0.05). Good concordance between UHFUS and histology was found. UHFUS showed 75% sensitivity in the diagnosis of PV and 66.7% in the diagnosis of MMP.Conclusions: UHFUS appears a valuable tool in the diagnosis of PV and MMP.Although histology and immunofluorescence remain the gold standard, UHFUS role in the diagnostic algorithm of PV and MMP seems promising as a chair-side tool consistently enhancing clinical evaluation of oral bullous lesions.

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“…The assessment of severity on ultrasound has been validated in multicentric studies and has shown very good intra and interrater agreements that are much higher compared to some of the widely used classifications of the clinical scorings commonly used in clinical trials. Moreover, the degree of severity detected on ultrasound is a critical finding that frequently causes a modification of the HS treatment 5,6,9–20 …”

Section: Figurementioning

confidence: 99%

“…Moreover, the degree of severity detected on ultrasound is a critical finding that frequently causes a modification of the HS treatment. 5,6,[9][10][11][12][13][14][15][16][17][18][19][20] Despite the strong evidence and the publications that mention ultrasound as a standard of care (not an optional) tool in HS, 11,14,17,21 nowadays, most of the clinical trials still do not consider ultrasound for the evaluation of new therapies, including biological drugs, which seems an unrealistic scenario for the real-world results of the treatments. Furthermore, suppose a drug proves later to be ineffective or poorly effective for the treatment.…”

mentioning

confidence: 99%

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

Wortsman

2023

J of Ultrasound Medicine

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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.

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High‐frequency ultrasound as a non‐invasive tool in predicting early hidradenitis suppurativa fistulization in comparison with the Hurley system

Cited by 6 publications

References 5 publications

Understanding Hurley Stage III Hidradenitis Suppurativa Patients’ Experiences With Pain: A Cross-Sectional Analysis

Understanding Hurley Stage III Hidradenitis Suppurativa Patients’ Experiences With Pain: A Cross-Sectional Analysis

Ultra‐high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study

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

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