Is Ultrasound Diagnosis and Staging Useful in Pediatric Hidradenitis Suppurativa?

In some cases, children can be affected by hidradenitis suppurativa (HS), a chronic inflammatory disease that affects the terminal follicle and presents with recurrent nodules and abscesses in the intertriginous regions. In these cases, presentation usually occurs during puberty. The condition is more common in young adults, particularly women in their 20s and 30s.

Ultrasound has been proven to be a useful tool in diagnosis and staging.  However, the sonographic characteristics of HS in children have not been reported in the literature, according to a new study, published online in Pediatric Dermatology.
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Because quality of life is poor with this disease, and management of children is reported to be more complicated, pediatric HS should be diagnosed and staged early, the authors said. The presence of HS in children is thought to be associated with hormonal factors, including a hyperandrogenemic state or premature adrenarche, but the etiology of HS remains to be determined, they added.

The researchers studied color Doppler ultrasound images of children (≤15 years old; N=12) with clinically and sonographically positive criteria for HS. Sonographic scoring of HS (SOS-HS) was used to stage the cases. Subclinical pseudocysts were identified in 92% of the cases. Fluid collections were noted in 83% of participants, while fistulous tracts were found in 58%. Retained hair tracts in the fluid collections and fistulous tracts were present in 100% of study participants; 67% of cases were SOS-HS stage II. In 92% of cases, management was modified after the ultrasound examination.

Ultrasound is a reliable and safe imaging tool to support diagnosis and staging of HS, and it could prove useful in the noninvasive monitoring of treatment in children, the researchers concluded.

Reference:
Wortsman X, Rodriguez C, Lobos C, Eguiguren G, Molina MT. Ultrasound diagnosis and staging in pediatric hidradenitis suppurativa [published online June 13, 2016]. Pediatr Dermatol. doi:10.1111/pde.12895.