High-frequency ultrasound in the diagnosis of Hidradenitis suppurativa: experience from the Bulgarian HS Expert Centre.

INTRODUCTION

Hidradenitis suppurativa (HS) is an immune-mediated, autoinflammatory skin disease with different clinical manifestations. Traditional clinical examination may not assess HS true extent, while high-frequency ultrasound can detect subclinical lesions, influencing severity assessments.

AIM

To compare the clinical severity of HS with the ultrasonography-based staging, and explore relationships between demographic data, risk factors and clinical phenotypes.

MATERIAL AND METHODS

An ongoing pilot study included 98 patients of the Bulgarian HS Expert Centre. Informed consent and epidemiological data were collected. Patients were categorized into disease duration groups (short/long) and classified by phenotype. Clinical severity was assessed through Hurley, IHS4, and HS-PGA staging systems and by ultrasound using SOS-HS, US IHS4, and US HS-PGA scales.

RESULTS

The study cohort was predominately male (74.5%) with a mean age of 36.69 years, average disease duration of 7.6 years and prevalence of the regular phenotype (53%). Age and disease duration correlated with Hurley stage ( < 0.05), but not with SOS-HS severity. Comorbidities correlated with disease duration (r = 0.256, = 0.01), and the follicular-furunculous phenotype was associated with the females ( = 0.04). Clinical and ultrasound assessments showed strong correlations, although ultrasound showed higher severity scores (r = 0.42 to 0.92, < 0.05), as well as significant differences across the phenotypes.

CONCLUSIONS

HS is often underestimated due to delayed diagnosis and atypical presentations. Combining clinical and ultrasound assessments can provide more accurate staging. A multidisciplinary approach in expert centres can enhance diagnosis, treatment and monitoring.