Disease severity assessment in hidradenitis suppurativa: A single-centre cross-sectional study utilising clinical evaluation, high-resolution ultrasound and colour doppler.

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterised by recurrent painful nodules, abscesses, and sinus tract formation in intertriginous areas. Accurate staging of this disorder is crucial for appropriate management and prognosis. The role of imaging in the staging of HS is still evolving. Objectives To assess the correlation between clinical disease severity staging and high-resolution ultrasonography and colour doppler (HRUS-CD) staging in HS patients. Methods This was a cross-sectional, single-centre study in patients above 18 years of age with the clinical diagnosis of HS. All patients underwent clinical examination and high-resolution ultrasonography and colour doppler study with high-frequency linear probe (L+ 8-24 MHz). Correlations between clinical Hurley staging and the various ultrasonographic parameters i.e. SOS-HS (sonographic staging of severity of HS), degree of vascularisation, fibrotic scarring and oedema were explored and analysed. Spearman's correlation coefficient was applied to study the correlations and p<0.05 was considered significant. Results A total of 46 patients with HS who met the inclusion criteria were included. The majority of patients were clinically in Hurley stages 1 (32.6%; n=15) and 2 (56.5%; n=26) (41 in all). However, on the basis of ultrasonographic findings, significant numbers of patients had greater severity of staging on SOS-HS (58.5%; n=24/41), higher vascularity on colour doppler (26.8%; n=11), more severe grading of fibrous scarring (43.9%; n=18) and oedema (68.2%; n=28) in comparison to the clinical Hurley staging. Limitations Limitations of our study include a small sample size and cross-sectional design. Conclusion The results of the study indicate that the majority of the patients were under-staged and under-treated clinically, hence emphasising the role of high-resolution ultrasonography and colour doppler study in the accurate determination of HS severity. Future research should focus on standardised protocols and larger, prospective studies to establish the role of these imaging modalities in routine clinical practice.