Comparison of Clinical and Ultrasonographic Severity Assessment in Hidradenitis Suppurativa: Prognostic Implications.
- 1Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- 2Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract
Background
Accurate assessment of hidradenitis suppurativa (HS) severity is crucial for individualized management, yet conventional clinical grading may underestimate disease extent due to subclinical lesions. Ultrasound enables visualization of deep abscesses and tunnels and may provide additional prognostic information.Materials and methods
Sixty-eight patients with HS underwent standardized clinical and ultrasonographic evaluation. Disease severity was classified using the International Hidradenitis Suppurativa Severity Score System (IHS4) and the modified Sonographic Scoring of HS (mSOS-HS). Concordance between the two systems was assessed, and ultrasonographic grading and features were analyzed in relation to achievement of IHS4-55 at week 12.Results
The mSOS-HS classified 18 patients (26.5%) as having more severe disease than IHS4. The two grading systems showed statistically significant agreement, with the Kappa value approaching the threshold for moderate agreement (Kappa = 0.395, 95% CI: 0.204-0.586, p < 0.001). Patients with higher mSOS-HS grades were less likely to achieve IHS4-55 at week 12 (p = 0.014). Among specific ultrasonographic features, the railway sign, defined as parallel hyperechoic lines within tunnel-like structures, was significantly associated with failure to achieve IHS4-55 (p = 0.003).Conclusion
Ultrasonography reveals subclinical HS involvement beyond clinical examination and provides prognostic information for treatment response. The mSOS-HS complements IHS4 for comprehensive disease staging, while the railway sign may serve as an imaging biomarker for unfavorable response across real-world treatment settings.
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BibTeX
@article{wang2026comparison,
title = {{Comparison of Clinical and Ultrasonographic Severity Assessment in Hidradenitis Suppurativa: Prognostic Implications.}},
author = {Juncheng Wang and Jing Qin and Xiao Ma and Mengyuan Zhou and Jie Liu and Qingli Zhu},
journal = {Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI)},
year = {2026},
month = oct,
doi = {10.1111/srt.70387},
url = {https://europepmc.org/article/MED/42960977},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparison of Clinical and Ultrasonographic Severity Assessment in Hidradenitis Suppurativa: Prognostic Implications.
AU - Juncheng Wang
AU - Jing Qin
AU - Xiao Ma
AU - Mengyuan Zhou
AU - Jie Liu
AU - Qingli Zhu
PY - 2026
DA - 2026/10/30
JO - Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI)
DO - 10.1111/srt.70387
UR - https://europepmc.org/article/MED/42960977
AB - Background Accurate assessment of hidradenitis suppurativa (HS) severity is crucial for individualized management, yet conventional clinical grading may underestimate disease extent due to subclinical lesions. Ultrasound enables visualization of deep abscesses and tunnels and may provide additional prognostic information.Materials and methods Sixty-eight patients with HS underwent standardized clinical and ultrasonographic evaluation. Disease severity was classified using the International Hidradenitis Suppurativa Severity Score System (IHS4) and the modified Sonographic Scoring of HS (mSOS-HS). Concordance between the two systems was assessed, and ultrasonographic grading and features were analyzed in relation to achievement of IHS4-55 at week 12.Results The mSOS-HS classified 18 patients (26.5%) as having more severe disease than IHS4. The two grading systems showed statistically significant agreement, with the Kappa value approaching the threshold for moderate agreement (Kappa = 0.395, 95% CI: 0.204-0.586, p < 0.001). Patients with higher mSOS-HS grades were less likely to achieve IHS4-55 at week 12 (p = 0.014). Among specific ultrasonographic features, the railway sign, defined as parallel hyperechoic lines within tunnel-like structures, was significantly associated with failure to achieve IHS4-55 (p = 0.003).Conclusion Ultrasonography reveals subclinical HS involvement beyond clinical examination and provides prognostic information for treatment response. The mSOS-HS complements IHS4 for comprehensive disease staging, while the railway sign may serve as an imaging biomarker for unfavorable response across real-world treatment settings.
SN - 0909-752X
SN - 1600-0846
ER -