Sinus Tract Formation in Hidradenitis Suppurativa – 3D Ultrasound Study of Severity and Hurley Staging

hs-hurley-ultrasound


 A 3D Ultrasound Study of Sinus Tract Formation in Hidradenitis Suppurativa

Imaging of hidradenitis suppurativa allows the study of both the lesion morphology and evolution. Hidradenitis lesions of different stages were studied using 3D ultrasound in a cross sectional pilot study. A total of 25 HS patients (18 female/ 7 male, aged 18-46 year-old) and 10 healthy controls (5 female/5 male, aged 21-49 year-old) were studied. All patients were referred by dermatologists. All examinations were performed on the right axilla and compared with both controls and the skin outside the lesional areas.

3D ultrasound images demonstrated enlargement of the deepest portion of the hair follicles in early stages. In more advanced stages dermal and subcutaneous sinus tracts were identified that were commonly connected to the base of the regional hair follicles. At the end stage of the disease, these sinus tracts were further dilated and multiple.

Ultrasound allows early detection and characterization of the morphological changes in hidradenitis, which include the variable degrees of involvement of the hair follicles and the appearance of fluid collections and sinus tracts. Knowledge of this anatomical information may allow the identification of lesions that can benefit from medical or surgical management.

“Hurley`s clinical criteria seem insufficient to provide categorical anatomical information on the underlying processes that occur in HS.”


Full Studyhttp://escholarship.org/uc/item/8m93q0xc



NORMAL SKIN
:  “Normal” 3D anatomy of the skin at the axilla

normal-anatomy

A: Normal 3D anatomy of the skin at the axilla

normal-anatomy-folicals

B: Normal 3D anatomy with the hair follicles outlined


Normal 3d Ultrasound of the skin at the axilla

Image A: 3d ultrasound 
Image B: Hair follicles 
outlined

Abbreviations: e, epidermis; d, dermis; st, subcutaneous tissue.

 



STAGE 1
: Early changes classified as Hurley 1 for patient

hurley-1-patient

A. Clinical image of a HS patient classified as Hurley 1

hurley-1-ultra

B. 3D Ultrasound

hurley-1-ultra-folical

C. Hair follicles have been outlined


Early changes classified as Hurley 1 for patient 

Image A: clinical image
Image B: 3d ultrasound
Image C: Hair follicles outlined

SUMMARY: Image C demonstrates predominant enlargement of the base of the hair follicles in the deep portion of the dermis

Abbreviations: e, epidermis; d, dermis; st, subcutaneous tissue.



STAGE 2
: HS at a later stage classified as Hurley 2 for patient

hurley2-1

A. Clinical image of a case classified as Hurley 2

hurley2-12

B. 3D ultrasound

hurley2-3

C. Hair follicles have been outlined


HS at a later stage classified as Hurley 2 for patient 

Image A: Clinical image of a case classified as Hurley 2
Image B: 3d Ultrasound
Image C: Hair follicles have been outlined

SUMMARY: Notice the predominant enlargement of the hair bulbs and the connection between the bulbs (right side of the image). The dermis presents increased thickness (white vertical line) and there is a long sinus tract (*) that connects the bottom of a hair follicle with the subcutaneous tissue.

Abbreviations: e, epidermis; d, dermis; st, subcutaneous tissue.

 


 

STAGE 3: End-stage changes classified as Hurley Stage 3

hurley3-1

A. Clinical image of a case classified as Hurley 3

hurley3-2

B. 3D ultrasound

hurley3-3

C. Hair follicles have been outlined


End-stage changes classified as Hurley 3

Image A: Clinical image of case classified as Hurley 3
Image B: 3D ultrasound
Image C: Hair follicles have been outlined

SUMMARY3D ultrasound images demonstrates a hypoechoic fluid collection (*) with echoes (debris) in the subcutaneous tissue and dermis, also connected to the base of the hair follicles. Notice the complete enlargement and connection of the base of the hair follicles (right half of the image)

Abbreviations: e, epidermis; d, dermis; st, subcutaneous tissue.

 


Hurley Classification

I : Single or multiple abscesses or nodules without sinus tracts or scarring

II : Single or multiple recurrent abscesses or nodules with sinus tract and/or scarring, disposed in widely separated lesions

III Multiple interconnected abscesses and sinus tracts across an entire area with diffuse or near-diffuse involvement.

 

“Hurley`s clinical criteria seem insufficient to provide categorical anatomical information on the underlying processes that occur in HS. Sonography can provide a missing link that may be needed to assess a more complete diagnosis based on both the anatomical criteria and the clinical findings.”



Dermatology Online Journal UC Davis, Department of Radiology and Department of Dermatology

Publication Date: 2013
Journal Issue: Dermatology Online Journal, 19(6)
Author: Wortsman, Ximena, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile Jemec, Gregor, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Denmark
Full Sourcehttp://escholarship.org/uc/item/8m93q0xc

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