Martorell Calatayud, Antonio; Alfageme Roldán, Fernando; Vilarrasa Rull, Eva; Ruiz Villaverde, Ricardo; Romaní de Gabriel, Jorge; García Martinez, Francisco Javier
; Vidal Sarro, D.; Velasco Pastor, V.; Ciudad Blanco, C.; Segura Palacios, J.M.; Rodríguez Bandera, A.I.; Pascual Ramírez, J.C.; Sancho Sánchez, C.; Michelena De Gorosábel, N.; Wortsman, X.
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.