Department of Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Radiology and Diagnostic Imaging Unit, Department of Clinic and Dermatological Research, San Gallicano Dermatological Institute IRCCS, Rome, Italy.
Dermatol Ther. 2021 Mar;34(2):e14804. doi: 10.1111/dth.14804. Epub 2021 Feb 7.
Fistulous tracts are the hallmark lesions of hidradenitis suppurativa (HS) and respond poorly to the currently available medical treatments. To evaluate the clinical and ultrasound features related with both healing and persistence of fistulous tracts in patients under treatment with adalimumab, a retrospective analysis of power-Doppler ultrasound (PD-US) images with fistulas in HS patients was performed. The clinical and sonographic staging of HS, body areas involved, and anatomic characteristics of the fistulous tracts were registered and graded. Chi-square test, univariate/multivariate Cox-regression analysis with clustered error, and Kaplan-Meier analysis were computed to analyze data. In total, 151 fistulous tracts from 33 HS patients were included. Age, BMI, length, thickness, subcutaneous pattern, high intensity of PD-US signal, and a high grade of fibrosis/edema were all related to a lower possibility of healing and a high risk of longer persistence at binomial Cox-regressions. Whereas, multivariate regressions showed that high fibrosis, was the variable with the highest risk of poor response and longer survival. Survival-analysis showed that fistulas with high fibrosis or PD-US signal have longer survival time than those with absent/low fibrosis or signal. Limitations include the impossibility to detect with ultrasound lesions less than 0.1 mm and smaller sample size. In conclusion, an accurate assessment of fibrosis may be crucial to define better when a surgical approach-besides the medical treatment-could be required. PD-US may assess the decrease of vascularization in HS lesions and consequently the reduction of inflammation due to immunomodulatory therapies.
瘘管是化脓性汗腺炎（HS）的标志性病变，对目前可用的医学治疗反应不佳。为了评估阿达木单抗治疗患者的愈合和瘘管持续存在相关的临床和超声特征，对 HS 患者的瘘管进行了超声（PD-US）图像的回顾性分析。登记和分级了 HS 的临床和超声分期、受累身体区域以及瘘管的解剖特征。进行了卡方检验、具有聚类误差的单变量/多变量 Cox 回归分析和 Kaplan-Meier 分析来分析数据。共纳入 33 例 HS 患者的 151 个瘘管。年龄、BMI、长度、厚度、皮下模式、PD-US 信号强度高和纤维化/水肿程度高均与愈合可能性降低和持续时间延长的风险增加有关。而多元回归显示，纤维化程度高是反应不良和生存时间延长的风险最高的变量。生存分析显示，纤维化程度高或 PD-US 信号高的瘘管的生存时间长于纤维化程度低或无信号的瘘管。局限性包括不可能通过超声检测小于 0.1 毫米的病变和样本量较小。总之，准确评估纤维化可能对确定何时需要手术治疗（除了药物治疗）至关重要。PD-US 可评估 HS 病变中血管生成的减少，从而减少免疫调节治疗引起的炎症。
