Real-time compound imaging ultrasound of hidradenitis suppurativa

BACKGROUND: Hidradenitis suppurativa (HS) is a difficult disease to treat. Surgery may be curative, but just like cancer surgery, it must be complete to effect a cure. Preoperative imaging of hidradenitis lesions is therefore of interest. OBJECTIVE: The objective was to study the ultrasound characteristics of hidradenitis and compare these to the clinical findings. MATERIALS AND METHODS: Real-time compound imaging ultrasound systems were used (Philips HDI 5000 and iU22) to visualize HS lesions in seven patients and regional controls images from eight healthy volunteers. RESULTS: Hidradenitis-related features were identified: various fluid collections, increased dermal thickness (mean±SD, 3.3±1.0 mm vs. 1.4±0.3 mm for controls) and lower echogenicity of the skin. In comparison with clinical examination, we were able to identify both subclinical lesions and subclinical extension of lesions into clinically normal looking paralesional skin. Hair follicles appeared distended. CONCLUSION: A number of HS features can be identified by ultrasound. These features include both actual lesions and possible predisposing factors such as skin thickness and hair follicle morphology. Ultrasonography can identify the true extent of lesions in HS, which may be of use in the preoperative planning.