Granieri Giammarco, Michelucci Alessandra, Manzo Margiotta Flavia, Cei Bianca, Vitali Saverio, Romanelli Marco, Dini Valentina
Department of Dermatology, University of Pisa, 56126 Pisa, Italy.
Diagnostic and Interventional Radiology, University Hospital of Pisa, 56126 Pisa, Italy.
Diagnostics (Basel). 2023 Aug 30;13(17):2802. doi: 10.3390/diagnostics13172802.
Pyoderma gangrenosum (PG) is a neutrophilic dermatological disease, whose pathogenesis is still poorly clarified. Because of the lack of validated criteria for diagnosis and response, PG treatment is still challenging and should be differentiated in the inflammatory and non-inflammatory phases. Our study aimed to provide a new semi-quantitative approach for PG diagnosis and monitoring, identifying ultra-high-frequency ultrasound (UHFUS) early biomarkers associated with the transition between the two phases. We enrolled 13 patients affected by painful PG lesions evaluated during the inflammatory phase (T0) and during the non-inflammatory phase (T1): pain was measured by the Visual Analogue Scale (VAS); clinical features were recorded through digital photography; epidermis and dermis ultrasound (US) characteristics were evaluated by UHFUS examination with a 70 MHz probe (Vevo MD FUJIFILM VisualSonics). In T1 UHFUS examination, the presence of hyperechoic oval structures was lower compared to T0 ( value < 0.05). An hyperechogenic structure within the oval structure, suggestive of a hair tract, was evident in T0 and absent in T1 ( value < 0.05). In T0, blood vessels appear as U-shaped and V-shaped anechoic structures with a predominance of U-shaped vessels ( value < 0.05) compared to the more regular distribution found in T1. Finding early biomarkers of the transition from the inflammatory to the non-inflammatory phase could provide new insight in terms of therapeutic decision making and response monitoring. The differences found by this study suggest a potential use of UHFUS for the development of an objective standardized staging method. Further investigations will be necessary to confirm our preliminary results, thus providing a turning point in PG early detection, differential diagnosis and treatment monitoring.
坏疽性脓皮病（PG）是一种嗜中性皮肤病，其发病机制仍未完全阐明。由于缺乏经过验证的诊断和反应标准，PG的治疗仍然具有挑战性，并且应在炎症期和非炎症期进行区分。我们的研究旨在为PG的诊断和监测提供一种新的半定量方法，识别与两个阶段之间转变相关的超高频率超声（UHFUS）早期生物标志物。我们招募了13名患有疼痛性PG病变的患者，在炎症期（T0）和非炎症期（T1）进行评估：通过视觉模拟量表（VAS）测量疼痛；通过数码摄影记录临床特征；使用70 MHz探头（Vevo MD FUJIFILM VisualSonics）通过UHFUS检查评估表皮和真皮的超声（US）特征。在T1 UHFUS检查中，高回声椭圆形结构的存在比T0时更低（值<0.05）。椭圆形结构内的高回声结构，提示毛囊，在T0时明显，在T1时不存在（值<0.05）。在T0时，血管表现为U形和V形无回声结构，与T1中发现的更规则分布相比，U形血管占优势（值<0.05）。找到从炎症期到非炎症期转变的早期生物标志物可以为治疗决策和反应监测提供新的见解。本研究发现的差异表明UHFUS在开发客观标准化分期方法方面具有潜在用途。需要进一步研究以证实我们的初步结果，从而为PG的早期检测、鉴别诊断和治疗监测提供转折点。
