Clinically relevant evidence on imaging and artificial intelligence in hidradenitis suppurativa.

This review provides a comprehensive analysis of the role of imaging and artificial intelligence in hidradenitis suppurativa (HS), highlighting the strengths and limitations of each modality and providing the level of evidence for each imaging technique. To date, ultrasound has emerged as the only modality with validated diagnostic criteria, standardized scoring systems and strong international multicentre evidence and consensus, supporting its role as the first-line tool for diagnosis, staging, pre-surgical mapping and treatment guidance in HS. Other techniques, such as dermoscopy, magnetic resonance imaging (MRI), computed tomography (CT), Positron Emission Tomography (PET)-CT, optical coherence tomography (OCT), medical infrared thermography and reflectance confocal microscopy (RCM), serve complementary or limited roles with a lower level of evidence in HS. Emerging artificial intelligence (AI) applications show promise for improving early detection, standardizing severity assessment and optimizing clinical workflows, though further validation and multicentre studies are required.