Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful nodules, abscesses, and tunnels that typically develop in skin folds. The condition can significantly affect a person’s quality of life due to its recurrent nature and potential for scarring. Managing HS often requires looking beyond visible symptoms, highlighting the role of advanced imaging. Ultrasound has emerged as a valuable tool for gaining deeper insights into this complex disease and guiding its care.
Why Ultrasound is Used for Hidradenitis Suppurativa
Ultrasound is a non-invasive imaging technique that uses high-frequency sound waves to create real-time images of structures beneath the skin’s surface. It is well-suited for assessing hidradenitis suppurativa because it visualizes deep skin layers and soft tissues without radiation. Its non-invasive nature makes it safe for repeated examinations and ongoing monitoring.
The real-time imaging provides immediate results, enabling quick decisions regarding diagnosis and treatment. Unlike a physical examination, which can only assess surface manifestations, ultrasound offers a detailed view of hidden lesions, including those in early stages or not yet visible. This ability to detect subclinical features complements traditional clinical assessment.
The cost-effectiveness and accessibility of ultrasound further support its integration into routine HS management, enhancing the understanding of the condition.
What Ultrasound Reveals in Hidradenitis Suppurativa
Ultrasound imaging provides a detailed view of specific abnormalities associated with hidradenitis suppurativa, many located beneath the skin’s surface. One common finding is dilated hair follicles, appearing as enlarged structures in the deeper skin layers. These follicles are often an early HS sign and may contain hair shaft fragments, contributing to inflammation.
The scan also reveals fluid collections, such as abscesses (pus-filled pockets) or pseudocysts (fluid-filled cavities), appearing as anechoic or hypoechoic areas within the dermis or subcutaneous tissue. These collections vary in size and depth, providing visual evidence of acute inflammation.
A characteristic feature visible on ultrasound is the presence of sinus tracts, also known as tunnels or fistulas. These appear as hypoechoic, band-like structures or linear tracts connecting different lesions, sometimes extending deep into the dermis and subcutaneous tissue. These tunnels can be simple or interconnected, forming complex networks not evident during a physical examination. Ultrasound can also show inflammatory changes in the surrounding dermal tissue, such as increased thickness and altered echogenicity.
How Ultrasound Guides Hidradenitis Suppurativa Management
The detailed information from ultrasound aids in the diagnosis and ongoing management of hidradenitis suppurativa. Ultrasound findings help confirm a diagnosis, particularly in cases where clinical presentation is atypical or early lesions are not yet apparent. For instance, detecting specific ultrasound features like dilated hair follicles and subclinical tunnels can help differentiate HS from other skin conditions.
The technology also plays a role in staging disease severity. While the Hurley staging system is commonly used clinically, ultrasound provides additional anatomical details that can refine this assessment. It can uncover hidden lesions, leading to a more accurate classification of disease severity. This enhanced staging, sometimes utilizing systems like the Sonographic Scoring System for HS (SOS-HS), helps tailor treatment plans more precisely.
Ultrasound is also used for monitoring disease progression and assessing treatment response. By visualizing changes in lesion size, inflammation, and sinus tract status, healthcare providers can determine if medical or surgical treatments are effective. If lesions are not improving or new ones appear, ultrasound can signal the need to adjust the treatment approach. Regular ultrasound examinations track how lesions respond over time, providing objective data on treatment efficacy.
Ultrasound guides specific interventions, especially surgical procedures. Before surgery, it helps map the exact location and extent of affected areas, including hidden sinus tracts and abscesses, allowing surgeons to plan more precise excisions. This pre-surgical mapping aims to ensure complete removal of diseased tissue, potentially reducing recurrence. Ultrasound can also guide drainage procedures for abscesses, ensuring accurate targeting of fluid collections.