Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study

J Eur Acad Dermatol Venereol. 2019 Nov;33(11):2137-2142. doi: 10.1111/jdv.15710. Epub 2019 Jun 23.


Background: It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS).

Objective: To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management.

Methods: Cross-sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared.

Results: Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P < 0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P < 0.01). Concordance between clinical and ultrasound intra-rater examination was 22.8% (P < 0.01); intra-rater and inter-rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P < 0.01).

Limitations: The inability to detect lesions that measure ≤0.1 mm or with only epidermal location.

Conclusion: Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Hidradenitis Suppurativa / diagnostic imaging*
  • Hidradenitis Suppurativa / therapy*
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Ultrasonography

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