Ultrasound: an indispensable tool to evaluate the outcome of surgical approaches in patients affected by hidradenitis suppurativa

Marasca, Claudio; Marasca, Dario; Megna, Matteo; Annunziata, Maria Carmela; Fabbrocini, Gabriella

doi:10.1111/jdv.16361

Cited by 14 publications

(7 citation statements)

References 7 publications

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“…neodymium:yttrium-aluminiumgarnet and Alexandrite) and other light therapies such as intense pulsed light and photodynamic therapy have been reported to have some efficacy for HS, but there has been little research into RF treatments, especially FMR. 15,16 FMR can deliver energy directly to the dermis via insulated microneedles without damaging the epidermis. 6,17 This enables short recovery times and fewer complications after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology

Yang

Cho

Kim

et al. 2021

Clin Experimental Derm

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Background. Hidradenitis suppurativa (HS) is a devastating chronic inflammatory skin disease with frequent recurrences. Various systemic treatments and procedures have been used but the efficacy of fractional microneedling radiofrequency (FMR) has not been reported. Aim. To evaluate the clinical and histological efficacy of FMR in the treatment of HS lesions.Methods. An 8-week, prospective, split-body, unblinded study was conducted, which enrolled 10 adult patients with mild to moderate HS to receive 3 sessions of FMR treatment biweekly. HS severity was assessed using the number and type of lesions, HS Physician Global Assessment (HS-PGA) and the modified Sartorius score (mSS). Skin biopsies were performed on participants to assess change in inflammation before and after FMR. Results. Severity of HS was significantly reduced on the FMR-treated side of the body, but not on the control side. Inflammatory HS lesions were significantly reduced after 4 weeks, while HS-PGA and mSS were significantly decreased after 6 weeks. Immunohistochemistry staining showed decreased expression of inflammatory markers including neutrophil elastases, interleukin (IL)-8 and IL-17, tumour necrosis factor-a, transforming growth factor-b1 and matrix metalloproteinases. Conclusion. FMR may be a viable treatment option for mild to moderate HS.

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Section: Discussionmentioning

confidence: 99%

Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology

Yang

Cho

Kim

et al. 2021

Clin Experimental Derm

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“…HFUS assessment of lesions before and after steroid infiltration has proven to improve the accuracy of skin lesion depth measurement, supporting diagnosis, staging, treatment plan and monitoring of treatment response. 14 , 19 , 20 UHFUS detects lesions <0.1 mm and small fluid collections with a better differentiation among HS lesions, thus improving patient monitoring. 6 Our data confirm that UHFUS is really useful in baseline assessment, in treatment planning, in managing the infiltration phases and in monitoring of treatment response.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided injection of intralesional steroids in acute hidradenitis suppurativa lesions: A prospective study

Iannone

Janowska

Oranges

et al. 2021

Dermatologic Therapy

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The management of hidradenitis suppurativa (HS) flares with intralesional steroids lacks strong scientific evidence but limited data suggest that it may be useful. The objective of this study is to assess the clinical and ultrasound responses of HS flares to ultrasound‐guided injections of intralesional triamcinolone (40 mg/ml) with a dilution 1:4 versus 1:2 at 30‐day (t1), 60‐day (t2), and 90‐day (t3) follow‐up. We recruited patients with ≤3 acute lesions, unresponsive to topical therapy. At baseline we assessed lesions clinically and by ultra‐high frequency ultrasound (48 or 70 MHz) and randomly performed an ultrasound‐guided injection of triamcinolone. Assessments were repeated at t1, t2, and t3 follow‐up, re‐injecting the lesion in the case of no or partial response. We treated 49 lesions: 38.8% showed improvements at t1; 46.9% at t2; 6% at t3; and 8.3% showed no clinical and ultrasound improvements. Long‐term follow‐up data confirmed a statistically significant reduction in Visual Analogue Scale (VAS)‐pain, Dermatology Life Quality Index (DLQI), and HS‐Physician Global Assessment (HS‐PGA), as well as edema and vascular signals. No adverse effects were reported. Our study suggests that ultrasound‐injections with a 1:2 dilution are beneficial for HS flares that do not respond to topical treatment and should be included in the therapeutic algorithm.

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“…Ultrasound (US) aids in the diagnosis and assessment of HS disease severity [28]. Different subclinical lesions have been identified and categorized using US, and their recognition is able to modify a therapeutic approach [29]. Wortsman and colleagues proposed a sonographic scoring system for HS (SOS-HS) that combined the results of parameters included in Hurley's classification with the relevant sonographic findings [28].…”

Section: Severity Assessmentmentioning

confidence: 99%

Hidradenitis Suppurativa: Where We Are and Where We Are Going

Scala

Cacciapuoti

Garzorz‐Stark

et al. 2021

Cells

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Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.

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Ultrasound: an indispensable tool to evaluate the outcome of surgical approaches in patients affected by hidradenitis suppurativa

Cited by 14 publications

References 7 publications

Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology

Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology

Ultrasound‐guided injection of intralesional steroids in acute hidradenitis suppurativa lesions: A prospective study

Hidradenitis Suppurativa: Where We Are and Where We Are Going

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