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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0044-1782624
Original Article

A Pilot Real-World Study of Ultrasonography Findings of Hidradenitis Suppurativa in Indian Patients and Its Diagnostic and Therapeutic Implications

Siddharth Gogate 
1   Department of Dermatology, Venerology and Leprosy, Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
,
Raghav Aggarwal
2   Dr M L Aggrawal Imaging Center, New Delhi, India
,
Kabir Sardana
1   Department of Dermatology, Venerology and Leprosy, Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
,
Sheetal Yadav
1   Department of Dermatology, Venerology and Leprosy, Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
,
Bulli Babu Boyidi 
3   Department of Plastic and Reconstructive Surgery, Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
,
Siddharth Siddharth 
4   Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
,
Pankaj Sharma 
5   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Abstract

Introduction Hidradenitis suppurativa (HS) is a multifactorial chronic inflammatory follicular disorder affecting apocrine gland-bearing areas of the body. We conducted an observational study to assess the ultrasonography (USG) findings in suspected HS patients at a tertiary care center in North India over 6 months.

Aim The aim of this article was to study the USG findings in HS and correlate clinical and USG findings and scoring systems in HS with stage wise treatments.

Materials and Methods All patients with a clinical suspicion of HS underwent an USG examination after clinical examination with a probe of 18 Hz frequency. Hurley's staging of patients was used to stage clinically, and the HS-SOS scoring and Doppler changes were assessed on USG. The treatment was revised in case of a change in the USG grading of severity.

Results A total of 23 patients suspected of HS underwent USG evaluation, of which 12 (52%) were male and 9 (48%) were females, with the mean age being 25.3 years (range: 14–40 years). Based on the HS clinical grading, eleven patients (47.8%) were Hurley's stage I, six patients (26%) were stage II, and six patients (26%) were stage III. USG demonstrated that three patients had been misdiagnosed and had folliculitis (8.6%) and Crohn's disease (4.3%). Out of the remaining twenty patients with USG features of HS, based on HS SOS grading, three patients (15%) were grade I, seven (35%) were grade II, and ten (50%) were grade III. Of these, nineteen patients (95%) had axillary involvement, which was bilateral in 84% of cases. The other region affected was the groin in five patients (26.3%), while two had inframammary involvement (10.5%). On further characterization of the type of lesion, nodules (41; 40.6%) were the most common type of lesion by sinuses and thickened hair follicles in 31 (30.6%) patients. Based on USG findings, the management of 26% of patients was changed from medical to surgical intervention.

Conclusion USG and Doppler are noninvasive bedside tools for the examination of HS, which helps to rule out differentials and delineate the extent and depth of the disease better by picking up subclinical lesions and help in determining disease activity by Doppler, which in turn helps in planning appropriate medical and surgical management of patients. It also identifies radiological parameters that help identify patients who could fail medical management.

Keywords

hidradenitis suppurativa - Cutaneous Ultrasound - Soft-tissue Ultrasound - Ultrasound in Dermatology - Ultrasound in Plastic Surgery - High-frequency Ultrasound - Treatment - Surgery - Biological

Supplementary Material



Publication History

Article published online:
09 May 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Singh R, Kelly KA, Senthilnathan A, Feldman SR, Pichardo RO. Stigmatization, a social perception which may have a debilitating impact on hidradenitis suppurativa patients: an observational study. Arch Dermatol Res 2023; 315 (04) 1049-1052
    CrossrefPubMedGoogle Scholar
  • 2 von der Werth JM, Jemec GB. Morbidity in patients with hidradenitis suppurativa. Br J Dermatol 2001; 144 (04) 809-813
    CrossrefPubMedGoogle Scholar
  • 3 Matusiak Ł, Bieniek A, Szepietowski JC. Hidradenitis suppurativa markedly decreases quality of life and professional activity. J Am Acad Dermatol 2010; 62 (04) 706-708 , 708.e1
    CrossrefPubMedGoogle Scholar
  • 4 Machado MO, Stergiopoulos V, Maes M. et al. Depression and anxiety in adults with hidradenitis suppurativa: a systematic review and meta-analysis. JAMA Dermatol 2019; 155 (08) 939-945
    CrossrefPubMedGoogle Scholar
  • 5 Thorlacius L, Cohen AD, Gislason GH, Jemec GBE, Egeberg A. Increased suicide risk in patients with hidradenitis suppurativa. J Invest Dermatol 2018; 138 (01) 52-57
    CrossrefPubMedGoogle Scholar
  • 6 Jfri AH, O'Brien EA, Litvinov IV, Alavi A, Netchiporouk E. Hidradenitis suppurativa: comprehensive review of predisposing genetic mutations and changes. J Cutan Med Surg 2019; 23 (05) 519-527
    CrossrefPubMedGoogle Scholar
  • 7 Chung MG, Preda-Naumescu A, Yusuf N. Hidradenitis suppurativa: consequences of microbiome dysbiosis on immune dysregulation and disease severity. Indian J Dermatol 2022; 67 (06) 699-704
    PubMedGoogle Scholar
  • 8 Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol 2015; 73 (5, Suppl 1): S52-S54
    CrossrefPubMedGoogle Scholar
  • 9 Garg A, Papagermanos V, Midura M, Strunk A. Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A. Br J Dermatol 2018; 178 (03) 709-714
    CrossrefPubMedGoogle Scholar
  • 10 Kaleta KP, Nikolakis G, Hossini AM. et al. Metabolic disorders/obesity is a primary risk factor in hidradenitis suppurativa: an immunohistochemical real-world approach. Dermatology 2022; 238 (02) 251-259
    CrossrefPubMedGoogle Scholar
  • 11 Karagiannidis I, Nikolakis G, Sabat R, Zouboulis CC. Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder?. Rev Endocr Metab Disord 2016; 17 (03) 335-341
    CrossrefPubMedGoogle Scholar
  • 12 Boer J, Jemec GBE. Mechanical stress and the development of pseudo-comedones and tunnels in hidradenitis suppurativa/acne inversa. Exp Dermatol 2016; 25 (05) 396-397
    CrossrefPubMedGoogle Scholar
  • 13 Gutfilen-Schlesinger G, Lopes de Souza SA, Gutfilen B. Should we scan hidradenitis suppurativa patients? A systematic review of radiologic findings. Adv Skin Wound Care 2021; 34 (07) 1-10
    CrossrefPubMedGoogle Scholar
  • 14 Alexander H, Miller DL. Determining skin thickness with pulsed ultra sound. J Invest Dermatol 1979; 72 (01) 17-19
    CrossrefPubMedGoogle Scholar
  • 15 Okoye GA. Hidradenits Suppurativa. In Kang S, Amagai M, Enk A. Eds. Fitzpatrick's Dermatology. 9th ed. New York: McGraw-Hill; 2019: 1485
    Google Scholar
  • 16 Wortsman X, Moreno C, Soto R, Arellano J, Pezo C, Wortsman J. Ultrasound in-depth characterization and staging of hidradenitis suppurativa. Dermatol Surg 2013; 39 (12) 1835-1842
    CrossrefPubMedGoogle Scholar
  • 17 Jemec GBE, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol 2015; 73 (5, Suppl 1): S4-S7
    CrossrefPubMedGoogle Scholar
  • 18 Kamat D, Gaba S, Kumaran MS. Clinico-epidemiological characteristics of hidradenitis suppurativa: a retrospective cohort study from a tertiary care centre in Northern India. Indian Dermatol Online J 2021; 12 (04) 561-565
    CrossrefPubMedGoogle Scholar
  • 19 Jemec GB, Gniadecka M. Ultrasound examination of hair follicles in hidradenitis suppurativa. Arch Dermatol 1997; 133 (08) 967-970
    CrossrefPubMedGoogle Scholar
  • 20 Wortsman X, Calderon P, Castro A. Seventy-MHz ultrasound detection of early signs linked to the severity, patterns of keratin fragmentation, and mechanisms of generation of collections and tunnels in hidradenitis suppurativa. J Ultrasound Med 2020; 39 (05) 845-857
    CrossrefPubMedGoogle Scholar
  • 21 Wortsman X. Imaging of hidradenitis suppurativa. Dermatol Clin 2016; 34 (01) 59-68
    CrossrefPubMedGoogle Scholar
  • 22 Nazzaro G, Zerboni R, Passoni E. et al. High-frequency ultrasound in hidradenitis suppurativa as rationale for permanent hair laser removal. Skin Res Technol 2019; 25 (04) 587-588
    CrossrefPubMedGoogle Scholar
  • 23 Wortsman X, Rodriguez C, Lobos C, Eguiguren G, Molina MT. Ultrasound diagnosis and staging in pediatric hidradenitis suppurativa. Pediatr Dermatol 2016; 33 (04) e260-e264
    CrossrefPubMedGoogle Scholar
  • 24 Martorell A, Giovanardi G, Gomez-Palencia P, Sanz-Motilva V. Defining fistular patterns in hidradenitis suppurativa: impact on the management. Dermatol Surg 2019; 45 (10) 1237-1244
    CrossrefPubMedGoogle Scholar
  • 25 Wortsman X, Castro A, Figueroa A. Color Doppler ultrasound assessment of morphology and types of fistulous tracts in hidradenitis suppurativa (HS). J Am Acad Dermatol 2016; 75 (04) 760-767
    CrossrefPubMedGoogle Scholar
  • 26 Oranges T, Vitali S, Benincasa B. et al. Advanced evaluation of hidradenitis suppurativa with ultra-high frequency ultrasound: a promising tool for the diagnosis and monitoring of disease progression. Skin Res Technol 2020; 26 (04) 513-519
    CrossrefPubMedGoogle Scholar
  • 27 Lyons AB, Zubair R, Kohli I, Hamzavi IH. Preoperative ultrasound for evaluation of hidradenitis suppurativa. Dermatol Surg 2019; 45 (02) 294-296
    CrossrefPubMedGoogle Scholar
  • 28 Salvador-Rodríguez L, Arias-Santiago S, Molina-Leyva A. Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa. Sci Rep 2020; 10 (01) 13363
    CrossrefPubMedGoogle Scholar
  • 29 Mehdizadeh A, Hazen PG, Bechara FG. et al. Recurrence of hidradenitis suppurativa after surgical management: a systematic review and meta-analysis. J Am Acad Dermatol 2015; 73 (5, Suppl 1): S70-S77
    CrossrefPubMedGoogle Scholar
  • 30 Ovadja ZN, Zugaj M, Jacobs W, van der Horst CMAM, Lapid O. Recurrence rates following reconstruction strategies after wide excision of hidradenitis suppurativa: a systematic review and meta-analysis. Dermatol Surg 2021; 47 (04) e106-e110
    CrossrefPubMedGoogle Scholar
  • 31 Power Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions - PubMed [Internet]. [cited 2023 Aug 30]. Accessed February 29, 2024 at: https://pubmed.ncbi.nlm.nih.gov/29224229/
    Google Scholar
  • 32 Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2010; 62 (02) 247-256
    CrossrefPubMedGoogle Scholar
  • 33 Wortsman X, Castro A, Morales C, Franco C, Figueroa A. Sonographic comparison of morphologic characteristics between pilonidal cysts and hidradenitis suppurativa. J Ultrasound Med 2017; 36 (12) 2403-2418
    CrossrefPubMedGoogle Scholar
  • 34 de Vasconcelos PT, Dácio-Ferreira J, Filipe PL. Scrotal elephantiasis secondary to recalcitrant hidradenitis suppurativa. Indian J Dermatol Venereol Leprol 2015; 81 (05) 524-525
    CrossrefPubMedGoogle Scholar
  • 35 Reyes-Baraona F, Herane MI, Wortsman X. et al. [Chilean clinical guideline for the management of hidradenitis suppurativa - executive summary]. Rev Med Chil 2021; 149 (11) 1620-1635
    PubMedGoogle Scholar