Abstract
Corticosteroid infiltrations of lesions in hidradenitis suppurativa (HS) appear to be beneficial to acute flares. The aim of this study is to evaluate the effectiveness and safety of ultrasound-assisted intralesional corticosteroid infiltrations to HS lesions. Prospective cohort study between February 2017 and February 2019 on patients with mild to severe HS and one or more inflammatory lesions. The study intervention was ultrasound-assisted intralesional infiltration of triamcinolone acetonide 40 mg/ml. The main outcome was the complete response rate of infiltrated lesions versus non-infiltrated lesions. Two hundred and forty-seven infiltrated inflammatory lesions and 172 non-infiltrated lesions were included. At week 12, 81.1% (30/37) of nodules, 72.0% (108/150) of abscesses and 53.33% (32/60) of draining fistulas presented complete response versus 69.1% (47/68), 54.3% (38/70) and 35.3% (12/34) respectively for the non-infiltrated lesions. The Hurley stage negatively correlated with complete response for abscesses and draining fistulas at − 0.17 (SD 0.06) p < 0.01 and − 0.30 (SD 0.13) p < 0.02 respectively. Ultrasound-assisted corticosteroid infiltration is a useful technique for the treatment of inflammatory HS lesions, with high and sustained response rates, especially for abscesses and small to medium-size simple draining fistulas. The likelihood of response correlates negatively with the Hurley stage.
Highlights
Corticosteroid infiltrations of lesions in hidradenitis suppurativa (HS) appear to be beneficial to acute flares
Intralesional corticosteroids can achieve more than symptomatic relief if they are administered with the appropriate technique, and may produce long-term or permanent remission of treated lesions due to the fibrosis generated in dermis and subcutaneous tissue through the use of high-potency corticosteroids
The results of our study show that ultrasound-guided intralesional corticosteroid injections can improve inflammatory lesions in HS patients in the long-term, for inflammatory nodules and abscesses and draining fistulas
Summary
Corticosteroid infiltrations of lesions in hidradenitis suppurativa (HS) appear to be beneficial to acute flares. Ultrasound-assisted corticosteroid infiltration is a useful technique for the treatment of inflammatory HS lesions, with high and sustained response rates, especially for abscesses and small to medium-size simple draining fistulas. The administration of intralesional corticosteroids for the treatment of acute inflammatory lesions in patients with hidradenitis suppurativa (HS) is a commonly-used procedure in clinical practice Current recommendations for their use are based on a multicentre study of 36 patients who only received intralesional corticosteroids to nodules or inflammatory abscesses with a follow-up period of 2 weeks[1]. (1) Patients older than 18 years with mild to severe HS, who were found to have one or more inflammatory lesions (inflammatory nodules, abscesses, draining fistulas) following physical and ultrasound examination and were candidates to be treated with intralesional corticosteroids. Inclusion criteria. (1) Patients older than 18 years with mild to severe HS, who were found to have one or more inflammatory lesions (inflammatory nodules, abscesses, draining fistulas) following physical and ultrasound examination and were candidates to be treated with intralesional corticosteroids. (2) Patients who had antibiotic or immunomodulatory treatment in the maintenance phase prior to the initial visit were included. (3) All patients gave informed consent for the technique to be carried out and to participate in the study
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