Ultrasound Is an Essential Tool for Accurately Staging Hidradenitis Suppurativa

Ultrasound equipment
Ultrasound equipment
A multicenter study indicated significant interobserver agreement between ultrasound examination and the reproducibility of clinical underestimation of hidradenitis suppurativa severity.

An ultrasound examination can modify the clinical staging and therapeutic management in hidradenitis suppurativa (HS) by detecting subclinical disease, according to a study published in the Journal of the European Academy of Dermatology and Venereology.

Patients with a confirmed clinical diagnosis of HS (ie, recurrent painful or suppurating lesions ≥2 times in 6 months) were recruited from 13 centers across Spanish-speaking geographic regions (n=143). Ultrasound scans were performed to detect inflammatory or noninflammatory nodules, abscesses, and draining or nondraining fistulas. The difference in diagnostic staging between physical and ultrasonographic examinations was the primary outcome measure. Researchers also examined the difference in therapeutic approach, count of nodules and abscesses and fistulas, and the intraobserver and interobserver correlations between assessment strategies.

There was a significant difference in the proficiency of clinical examination and ultrasound examination when scoring Hurley stage. Hurley stage I, II, and III were scored in 38, 70, and 35 patients, respectively, with clinical examination and in 21, 80, and 42 patients, respectively, with ultrasound assessment (P <.01). Up to 44.7% of patients with stage I classification identified by clinical examination moved to a stage of greater severity.

Maintenance, increase, or decrease in treatment was indicated in 44.1%, 54.5%, and 1.4% of patients who underwent clinical examination vs 31.5%, 67.1%, and 1.4% of patients who underwent ultrasound examination, respectively (P <.01). The was a 22.8% concordance between both examination methods (P <.01). Likewise, the intrarater agreement was 94.9% and interrater ultrasound agreement was 81.7% (P <.01).

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A limitation of the study was the inability to identify lesions measuring ≤0.1 mm.

“Implementation of ultrasound examination can help to decrease the performance of late, blinded, or multiple invasive procedures,” the researchers wrote, “with the consequential scarring, which can positively impact the quality of life of these patients.”

Disclosure: This study was sponsored by Abbvie. Abbvie contributed to study design, study conduct, interpretation of data, writing, reviewing, and approving the publication. Multiple authors disclosed affiliations with pharmaceutical companies. See the reference for complete disclosure information.

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Martorell A, Alfageme Roldán F, Vilarrasa Rull E, et al. Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicenter study [published online May 24, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15710