To the Editor Drs Saunte and Jemec performed an illustrative review focused on the advances in diagnosis and treatment of hidradenitis suppurativa (HS).1 However, the advances in imaging of the disease were not discussed.
For example, regarding the pathogenesis, ultrasound studies have allowed visualization of the hidden connections between the tunnels or fistulous tracts and fluid collections and the dilated and ruptured base of the hair follicles, which were illustrated in Figure 3 in the article.1-3 Regarding the staging of hidradenitis, ultrasonography has also demonstrated that clinical evaluation and commonly used clinical scoring systems can miscategorize as healthy skin corporal segments with fluid collections or fistulous tracts underneath.3 The latter findings on imaging can be critical because, as pointed out by the authors, the choice of therapy is guided by disease severity. Currently, color Doppler ultrasound can support the detection of key subclinical lesions, the staging of the disease, and the assessment of activity and has been added to the clinical evaluation of hidradenitis in many centers around the world.3,4 Moreover, ultrasound is also being used in ongoing trials.
Wortsman X. Diagnosis and Treatment of Hidradenitis Suppurativa. JAMA. 2018;319(15):1617–1618. doi:10.1001/jama.2018.0814
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