Usefulness of high‐frequency ultrasonography in the evaluation and monitoring of sclerosing dermatoses: a cohort study

Abstract

Background. Monitoring of disease activity in sclerosing dermatoses (SD) can be challenging and tools to support clinical decision-making are lacking. Aim. To analyse the impact of high-frequency ultrasonography (HFUS) on the clinical management of SD and to describe the US characteristics of disease activity. Methods. This was a cohort study of patients with various SD [morphoea, systemic sclerosis (SS) and chronic graft-versus-host disease (cGvHD)] who underwent HFUS between January 2017 and August 2019. HFUS criteria for diagnosing active SD were increased Doppler vascularity and/or meeting all B-mode greyscale US signs of activity. Discordance in SD activity between HFUS and clinical examination was evaluated at the time of the first US assessment. Changes in patient management were instituted after HFUS were recorded. Results. In total, 72 patients (31 with morphoea, 19 with SS and 22 with cGvHD), who underwent 163 HFUS sessions in total, were included. All HFUS-active morphoea lesions exhibited increased vascularity, and all HFUS-active SS exhibited dermal thickening and dermal hypoechogenicity. HFUS-active cGvHD displayed increased dermal thickness and loss of definition of the dermal-hypodermal junction, and there were signs of panniculitis in 80% of cases and of increased vascularity in 70%. Discordance in disease activity between clinical and HFUS evaluation was found in 17 (23.6%) patients. Changes in clinical management after HFUS were made for 14 (19.4%) patients: treatment discontinuation for 6 patients (42.9%), treatment initiation for 5 (35.7%), medication change for 2 (14.3%) and skin biopsy taken for 1 (7.1%). Conclusion. HFUS seems an efficacious support tool in the monitoring of SD activity with a notable impact on clinical management. Further studies are warranted to evaluate the impact of HFUS-supported management changes on SD outcomes.

Top applications of dermatologic ultrasonography that can modify management

“…14). 1,10,11,27,[90][91][92][93][94][95][96] Recently, a scoring for assessing the degree of activity of morphea has been reported. This scoring is called US-MAS and can determine the basal and the follow-up degree of activity through the measurement of grayscale and color Doppler parameters.…”

Sonographic findings of COVID‐Arm: A case series

“…It can be carried out at the office and aids in therapeutic decision making, by comparing clinical and imaging findings. In inflammatory diseases, HFUS is helpful to define the site of involvement (whether dermal, hypodermic, or both) and quantify vascularisation 8,10 . In panniculitis, HFUS has proven helpful in assessing lobular, septal, or mixed patterns.…”

“…The variables analysed in mode B of the HFUS considered to be indicative of inflammation were hypoechogenicity of the dermis, hyperechogenicity of lobes in all cases with or without hypoechogenicity and thickening of the subcutaneous septa. 3 , 8 Increased or decreased echogenicity was considered in comparison with healthy perilesional and contralateral skin. Septa were considered thickened if 3 or more septa were thicker than 1 mm.…”

“…6 High-frequency ultrasound (HFUS) 7 aids in the diagnosis and follow-up of inflammatory skin diseases. 8 We describe herein the ultrasound characteristics of local injection-site cutaneous adverse reactions after vaccination against SARS-CoV-2.…”

High-Frequency Ultrasound to Assess Activity in Connective Tissue Panniculitis

“…HFUS appears to be helpful in the follow-up of sclerosing autoimmune diseases, such as morphea and systemic sclerosis. It assists in determining the activity of these diseases with a notable impact on clinical management [29,30]. In systemic sclerosis, an excellent correlation of HFUS findings with dermal collagen content has been demonstrated.…”