Commentary on Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa

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In this issue of Dermatologic Surgery, Martorell and colleagues1 proposes a standardized vocabulary and format for reporting the outcomes of untrasonography of Hidradenitis suppurativa (HS). It is a timely publication, and although it may not be the ultimate result, it is an important milestone in the management of this complex disease.
Although new knowledge on HS is growing at a fast pace, the world literature on the topic is still manageable, so now is the right moment in time to agree on nomenclature. A standardized nomenclature will provide the background for a more evidence based development within HS than in many other diseases, where the need for standardization only became apparent later in the process. Standardization in assessment requires explicit descriptors. This has been addressed in the clinical examination of HS2,3 but is equally important when imaging the disease. Based on the extensive experience of the authorship of this article, there is now a suggested standard for HS4–10 that may provide a skeleton for a more precise future academic and clinical discussion about the imaging of this troublesome disease.
In addition, the article indicates the practical utility of using ultrasound imaging in this disease which is characterized by predominantly dermal pathology and therefore, difficult to assess clinically.11 Treatment involves medical, surgical, and adjuvant therapy.12 Numerous surgical techniques have been described and patient satisfaction is generally good but recurrences are not uncommon because of the generalized nature of the disease and a better preoperative assessment may, therefore, be of practical value.13–18 It is acknowledged that, the complete removal of chronic lesions is of great importance, and today this may require in vivo dyes19 or magnetic resonance imaging (MRI),20 which may to some degree be replaced by ultrasound, although the most complex cases will still require MRI to exclude true fistula formation. Finally, the use of ultrasound may improve the diagnosis of Marjolin ulcers in HS, which is a rare but serious complication.

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