Dados do Trabalho

Título

Ultrasound Findings in Hidradenitis Suppurativa: A Diagnostic Challenge

Introdução e objetivo(s)

Hidradenitis suppurativa is a chronic, systemic, recurrent, and debilitating inflammatory disease of the hair follicle. It is characterized by the presence of deep, painful inflammatory lesions in body areas that contain apocrine glands, primarily the axillae, inguinal, gluteal, mammary, abdominal, and perineal regions. In some cases, it may also affect the scalp, neck, face, ears, and retroauricular region. On clinical examination, typical lesions such as comedones, papules, follicular pustules, and nodules can be identified.
The clinical diagnostic and staging criteria of Hurley have been used to categorize the disease into three stages. Ultrasound, particularly with color Doppler equipment operating with transducers of 15 MHz or higher, supports early diagnosis, staging, assessment of inflammatory activity, and disease monitoring.
The aim of this pictorial review is to present the ultrasound findings in hidradenitis suppurativa used for staging its severity according to the SOS-HS classification.

Método(s)

A search was conducted in the digital archive of representative cases with the main ultrasound findings, using equipment with 22 MHz transducers, in patients referred with a diagnosis of hidradenitis suppurativa.

Discussão

The diagnosis of hidradenitis suppurativa is clinical; however, it has low sensitivity as these lesions can be found in the dermal and subcutaneous layers of the skin, which reduces the precision in identifying nodules, sinuses, and fistulous tracts. This creates difficulty in differentiating between an abscess and a recurrent fistula, which is crucial when deciding whether the approach should be medical or surgical.

The value of ultrasound and its ability to identify both clinical and subclinical disease, demonstrated in this review, along with careful clinical evaluation, can significantly improve diagnosis, follow-up, and monitoring of disease progression, facilitating the decision regarding the most appropriate treatment.

In the reviewed exams, it was possible to identify all the elements mentioned in the SOS-HS classification, which correspond to: thickening and altered echogenicity of the dermis, follicular widening, collections, nodules, pseudocysts, and fistulous tracts.

Conclusões

Ultrasound is an indispensable tool for the diagnosis, characterization, staging, and follow-up of patients with hidradenitis suppurativa. Adequate knowledge of the disease's presentation forms contributes to treating this pathology.

Palavras Chave

hidradenitis suppurativa; Skin ultrasound

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