Michelucci Alessandra, Granieri Giammarco, Cei Bianca, Manzo Margiotta Flavia, Janowska Agata, Oranges Teresa, Romanelli Marco, Dini Valentina
Department of Dermatology, University of Pisa, Pisa, Italy.
Interdisciplinary Center of Health Science, Sant'Anna School of Advanced Studies of Pisa, Pisa, Italy.
J Ultrasound Med. 2025 Apr;44(4):739-745. doi: 10.1002/jum.16635. Epub 2024 Dec 21.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting hair follicles, causing recurrent abscesses and nodules in intertriginous regions. The International HS Severity Score System (IHS4) is widely used to assess HS severity by counting inflammatory nodules, abscesses, and draining fistulas/tunnels. However, traditional clinical examinations may underestimate HS severity due to the presence of subclinical lesions. This study aims to enhance the accuracy of HS severity assessment by incorporating ultra-high frequency ultrasound (UHFUS) to detect subclinical lesions, such as microtunnels.
A cohort of 122 patients with HS (75 females and 47 males) was evaluated. Clinical severity was assessed using the IHS4 scoring system. UHFUS assessments were performed using a 70 MHz probe for patients with mild and moderate IHS4 scores. Statistical tools were used to assess the significance of UHFUS in detecting additional lesions not identified during clinical examinations.
The study found that 23% of patients had mild HS, 58.2% had moderate HS, and 18.9% had severe HS according to IHS4. Among the 28 patients with mild IHS4, 14 had microtunnels detected by UHFUS, leading to a change in disease staging: 11.5% of patients were reclassified as mild, while 69.7% were reclassified as moderate. A statistically significant difference in the distribution of severity classifications before and after UHFUS examination was observed (χ = 5.11, P = .0238).
The study underscores the critical role of UHFUS as a non-invasive technique for the precise assessment of HS. The integration of UHFUS with a 70 MHz probe significantly enhances the detection of subclinical lesions, such as microtunnels, enabling timely intervention and potentially preventing disease progression. Despite the study's limitations, including its monocentric design and small sample size, the findings support the use of UHFUS in improving the accuracy of HS severity assessment.
化脓性汗腺炎（HS）是一种影响毛囊的慢性炎症性皮肤病，可在皮肤褶皱部位引起反复发作的脓肿和结节。国际HS严重程度评分系统（IHS4）通过计数炎性结节、脓肿和引流性瘘管/窦道来广泛评估HS的严重程度。然而，由于存在亚临床病变，传统的临床检查可能会低估HS的严重程度。本研究旨在通过纳入超高频率超声（UHFUS）以检测亚临床病变（如微窦道）来提高HS严重程度评估的准确性。
对122例HS患者（75例女性和47例男性）进行了队列研究。使用IHS4评分系统评估临床严重程度。对于IHS4评分轻度和中度的患者，使用70 MHz探头进行UHFUS评估。使用统计工具评估UHFUS在检测临床检查中未发现的额外病变方面的意义。
根据IHS4，研究发现23%的患者患有轻度HS，58.2%患有中度HS，18.9%患有重度HS。在28例IHS4轻度的患者中，14例通过UHFUS检测到微窦道，导致疾病分期发生变化：11.5%的患者重新分类为轻度，而69.7%重新分类为中度。UHFUS检查前后严重程度分类分布存在统计学显著差异（χ = 5.11，P = .0238）。
该研究强调了UHFUS作为一种用于精确评估HS的非侵入性技术的关键作用。将UHFUS与70 MHz探头相结合可显著提高对亚临床病变（如微窦道）的检测，从而实现及时干预并可能预防疾病进展。尽管该研究存在局限性，包括单中心设计和样本量小，但研究结果支持使用UHFUS来提高HS严重程度评估的准确性。
