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

Abstract

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.

Clinical application of ultra‐high frequency ultrasound: Discovering a new imaging frontier

“…Chao et al 9 demonstrated that the thickness and stiffness of plantar soft tissue in diabetic patients were higher compared with healthy subjects. Iannone et al 10 demonstrated, with the use of 48‐ and 70 MHz‐UHFUS, the responses of hidradenitis suppurativa flares to ultrasound‐guided injections of intralesional triamcinolone. Moreover, Oranges et al 11 concluded that UHFUS allows a better evaluation of hidradenitis suppurativa preventing the most severe changes.…”

Intralesional steroid injections to target sinus tract fibrosis in hidradenitis suppurativa: Results from an ultrasound‐based retrospective study

“…We have read with great interest the study published by Iannone and coworkers entitled "Ultrasound-guided injection of intralesional steroids in acute hidradenitis suppurativa lesions: A prospective study". 1 For this reason, we would like to share our experience in managing hidradenitis suppurativa (HS) fistulas with fibrotic features by ultrasound-guided intralesional steroid injections.…”

“…8 Our study has to strength to focus on the fibrotic degree of draining fistulas, since this sonographic parameter was not analyzed separately in the two aforementioned studies, and represented an exclusion criterion for Iavannone and coworkers. 1 We did not measure the total length of draining sinuses due to the lack of extended field-of-view ultrasound imaging software; also, we believed that intra or perifistular fibrosis could impact the correct sampling of sinus thickness.…”

Serum Amyloid A: A Potential New Marker of Severity in Hidradenitis Suppurativa

“…Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease, characterized by recurrent and painful nodules, abscesses, and sinus tracts involving the hair follicle of intertriginous areas, with systemic inflammation [1]. Despite the high impact on quality of life and the development of psychiatric comorbidities, treatment strategies are still limited and inadequate with poor understanding of the cytokine network underlying inflammation [2].…”