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Digital archive of theses discussed at the University of Pisa


Thesis etd-12122019-100855

Thesis type
Tesi di dottorato di ricerca
Thesis title
Hidradenitis suppurativa: advances in diagnostic and therapeutic work-up
Academic discipline
Course of study
tutor Prof. Romanelli, Marco
  • diagnosis
  • Hidradenitis suppurativa
  • treatment
  • ultrasound
Graduation session start date
The aim of the project was to better characterize hidradenitis suppurativa (HS), which is a chronic, recurrent, inflammatory disease with a main diagnostic delay of 7 years and a strong impact in the patient’s quality of life. We evaluated the comorbidities, the complications, the impact in the quality of life, the better diagnostic tools and the treatment outcomes. Considering that the global estimates of prevalence ranges from 0.03% to 4% of the population, the comorbidities and the sex-related differences in HS were analyzed in multicentric studies, collecting 234 and 124 patients respectively. The disease generally appears after puberty and there are only few cases reported in the literature in younger children. The pediatric population was evaluated in collaboration with the Hospital for Sick Children (Toronto, Canada) and other 8 centers in a multicentric retrospective study which included 481 pediatric patients. For evaluating the best way to diagnose and manage HS, we analyzed the role of High Frequency Ultrasound (HFUS) and Ultra High Frequency Ultrasound (UHFUS). The comparison of clinical and ultrasound scores using HFUS in the HS patients was performed in collaboration with the Italian ultrasound working group, showing that the severity of HS assessed only by clinical examination can be underestimated. The UHFUS (Vevo®MD, Visualsonics, Toronto, Canada) is provided by three different probes (22-48-70 MHz) and is characterized by a very high resolution (30 micron). Sonographic criteria for diagnosis HS using HFUS have been described (SOS-HS score), but UHFUS showed the detection of early signs and small sub-clinical changes in HS, which were not previously detectable. These new findings can help to better understand the evolution of the diseases from early to advanced stages and to perform an early diagnosis. The identification of early findings may also allow a better treatment monitoring of the patients and a detailed pre-surgical mapping in patients who are candidate for surgery. We also evaluated the topical treatments, analysing both the pre-surgical lesions and the post-surgical lesions. In particular, in order to better assess the topical management of HS, we described a new tool based on the main principles of the wound bed preparation in wound healing, called HS-TIME. We moreover described the efficacy of adalimumab in 11 adult patients and the case of a young girl suffering from HS, treated with a combination of surgical procedures and adalimumab for 4 years, with good results. The prevalence of HS is underestimated and a correct early diagnosis may help to prevent severe complications. Further investigations studies are needed to determine the efficacy of the new diagnostic tools and the different treatments in HS. In order to promote a multidisciplinary approach on diseases which may be better managed by the use of cutaneous ultrasonography we founded the first international society of cutaneous ultrasound (ISCU). The main aim of the society is to encourage muti-centric, interdisciplinary research projects, based on the ultrasonographic study of skin and subcutaneous tissue.