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Hidradenitis suppurativa with facial location. A case report.
Authors: Castro Diego S. J; Sueldo Maira
1Clinical History
A male patient, 16 years old, 170 cm, 65 kg, from the south of Tucumán, north province of Argentina wich was referenced to the private center of Ultrasound in San Miguel of Tucumán for an ultrasound examination with suspicious of hidradenitis suppurativa.
He has a skin disease consisting of papules, nodules and cysts with 2 years of evolution. These lesions were painful with location on face (Fig. 1,2), back and gluteus area. He started a topic treatment without response.
He has a skin disease consisting of papules, nodules and cysts with 2 years of evolution. These lesions were painful with location on face (Fig. 1,2), back and gluteus area. He started a topic treatment without response.
2Image Findings
High resolution ultrasound including a Doppler study with a 15 MHz probe was performed on the painful areas. On face, at the glabella, he has key lesions as connected fistulous tracts with located in the derm, with hypoechoic pattern and high vascularization (Fig. 3). On both malar regions, cheeks and mandibular areas, he has multiples fistulous tracts, all painful, all connected to each other. The fistulas have dermal and hypodermal location, with hypoechoic pattern and high degree of vascularization (Fig.4,5).
On the submental area with dermal location, he has a long fistulous tract, painful, with hypoechoic pattern and high degree of vascularization (Fig.6).
All main lesions described had severe dermal thickness with severe cellulitis.
On gluteous area he has a fistulous tract with a pseudocyst lesion (Fig.7).
On the submental area with dermal location, he has a long fistulous tract, painful, with hypoechoic pattern and high degree of vascularization (Fig.6).
All main lesions described had severe dermal thickness with severe cellulitis.
On gluteous area he has a fistulous tract with a pseudocyst lesion (Fig.7).
3Diagnosis
Hidrosadenitis supurativa Grade 3 B (m-SOS HS)- Ultrasound
Hidradenitis Suppurativa Activity Scoring (US-HSA): 18 point / max=18
Hidradenitis Suppurativa Activity Scoring (US-HSA): 18 point / max=18
4Discussion
BACKGROUND:
Hidradenitis suppurativa is a chronic, recurrent, debilitating, mutilating and potentially disabling systemic autoinflammatory disease that begins in the hair follicle, in areas of greater density of apocrine glands.
The lesions can be sub divided into dynamic lesions (such as nodules, abcess and fistulous tracts) and static lesions (that include not inflammatory fistulous tracts and scar tissue).
Due to the mutilating evolution, it is necessary to implement timely therapies depending on the severity of the lesions (“Modified window of opportunity#. Phrase used at the 2019 Dermatology Congress in Milan).
For this reason, according to the international group of experts, ultrasound is highly recommended to support the diagnosis but also in staging, monitoring, management (including treatment) and research on HS.
This is consistent with strong evidence from the literature and constitutes the first Delphi study to validate the usefulness of ultrasound in HS.
CLINICAL PERSPECTIVE:
By using Secukinumab we aim to reduce reduce the size of the lesions, relieve pain and improve the patients´s quality of life.
THERAPY PLANNING:
Use of Secukinumab.
OUTCOME & PROGNOSIS:
Outcome: Secukinumab has demonstrated efficacy in the treatment of moderate to severe active hidradenitis suppurativa in two identical randomized, double-blind, placebo-controlled, maintenance-phase clinical trials.
Prognosis: According to the available multicenter studies a 52-weeks treatment will reduce the size of the lesions, relieve skin pain , reduce the appearance of disease outbreaks and improve the patient's quality of life.
Hidradenitis suppurativa is a chronic, recurrent, debilitating, mutilating and potentially disabling systemic autoinflammatory disease that begins in the hair follicle, in areas of greater density of apocrine glands.
The lesions can be sub divided into dynamic lesions (such as nodules, abcess and fistulous tracts) and static lesions (that include not inflammatory fistulous tracts and scar tissue).
Due to the mutilating evolution, it is necessary to implement timely therapies depending on the severity of the lesions (“Modified window of opportunity#. Phrase used at the 2019 Dermatology Congress in Milan).
For this reason, according to the international group of experts, ultrasound is highly recommended to support the diagnosis but also in staging, monitoring, management (including treatment) and research on HS.
This is consistent with strong evidence from the literature and constitutes the first Delphi study to validate the usefulness of ultrasound in HS.
CLINICAL PERSPECTIVE:
By using Secukinumab we aim to reduce reduce the size of the lesions, relieve pain and improve the patients´s quality of life.
THERAPY PLANNING:
Use of Secukinumab.
OUTCOME & PROGNOSIS:
Outcome: Secukinumab has demonstrated efficacy in the treatment of moderate to severe active hidradenitis suppurativa in two identical randomized, double-blind, placebo-controlled, maintenance-phase clinical trials.
Prognosis: According to the available multicenter studies a 52-weeks treatment will reduce the size of the lesions, relieve skin pain , reduce the appearance of disease outbreaks and improve the patient's quality of life.
5Teaching Points
High resolution ultrasound including Doppler is highly recommended in the diagnosis, staging, monitoring and management of patients suffering from hidradenitis suppurativa.
6References
[1.] Wortsman X, Alfageme F, Dini V, García-Martínez F et al. International consensus statement on the use of ultrasound in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2025 Feb 18. doi: 10.1111/jdv.20600
[2.] Martorell A, Jfri A, Koster SBL, et al. Defining hidradenitis suppurativa phenotypes based on the elementary lesion pattern: results of a prospective study. J Eur Acad Dermatol Venereol 2020; 34(6): 1309-1318.
[3.] Sociedad Argentina de Dermatología. (2024). Consenso Nacional de Hidradenitis supurativa 2024.
[4.] Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol 2015; 29(4): 619-644
[2.] Martorell A, Jfri A, Koster SBL, et al. Defining hidradenitis suppurativa phenotypes based on the elementary lesion pattern: results of a prospective study. J Eur Acad Dermatol Venereol 2020; 34(6): 1309-1318.
[3.] Sociedad Argentina de Dermatología. (2024). Consenso Nacional de Hidradenitis supurativa 2024.
[4.] Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol 2015; 29(4): 619-644
