Advanced Imaging Essential for Accurate Hidradenitis Suppurativa Assessment, Suggests Study

Hidradenitis suppurativa is a debilitating, chronic inflammatory disorder where physical examination often fails to capture the true anatomical depth of lesions because severe pain and swelling hinder accurate manual palpation. Previous research highlights the promise of imaging in dermatology, yet a significant clinical gap remains in routine staging accuracy; consequently, lead authors Dr. Sophia Rao and Dr. Sunil Dogra from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, conducted the study to correlate clinical Hurley staging with findings from high-resolution ultrasonography and colour doppler (HRUS-CD).

Therefore, the cross-sectional, single-centre study involved 46 adult patients in India, utilizing a high-frequency 8–24 MHz linear probe to analyze deep tissue structures such as fluid collections and widened hair follicles. The methodology excluded individuals with prior excisional surgeries or those unable to tolerate imaging due to extreme suppuration, with the primary endpoint focused on establishing the correlation between clinical staging and the more detailed sonographic staging of severity of HS (SOS-HS).

Key Clinical Findngs of the Study Include:

• Sonographic Re-staging: In the study 58.5% of participants were found to be at a more advanced disease stage on ultrasound than their clinical Hurley classification originally suggested.

• Heightened Vascularity: Color doppler identified that 26.8% of patients exhibited significantly more severe inflammatory vascularity than was detectable through standard physical examination.

• Advanced Fibrosis: Imaging revealed more severe grading of fibrous scarring in 43.9% of cases, uncovering permanent tissue damage that clinical palpation frequently missed.

• Deep-seated edema: Analysis: A remarkable 68.2% of patients demonstrated more severe subcutaneous edema on imaging than their clinical stage implied, emphasizing the hidden depth of inflammation.

The results suggest that relying solely on physical examinations leads to the under-staging and potential under-treatment of over half the patient population, as bedside assessments fail to visualize the true anatomical extent of subcutaneous damage. This highlights the indispensable role of high-resolution imaging in providing the structural details necessary for effective presurgical mapping and predicting treatment responses.

Thus, the study concludes clinicians might consider utilizing these imaging modalities to better identify highly vascular lesions, which potentially indicates a need for initial medical therapy to control acute inflammation before proceeding with definitive surgical options.

While limited by a small sample size and a cross-sectional design, this work highlights the exciting need for larger prospective studies using dynamic tools like the International HS Severity Score System to further establish ultrasound's role in routine clinical practice.

Reference

Rao S, Sharma A, Kumaran M S, Narang T, Sinha A, Dogra S. Disease severity assessment in hidradenitis suppurativa: A single-centre cross-sectional study utilising clinical evaluation, high-resolution ultrasound and colour doppler. Indian J Dermatol Venereol Leprol. 2025;91:145-51.