LETTERS AND COMMUNICATIONS
CAITRIONA B. HACKETT, MRCPI JAMES A. A. LANGTRY, MBBS, FRCP Department of Dermatology Royal Victoria Infirmary Hospital Newcastle upon Tyne, UK
4. Rajan N, Ryan J, Langtry JAA. Squamous cell carcinoma arising within a facial port-wine stain treated by Mohs micrographic surgical excision. Dermatol Surg 2006;32:864–6. 5. Del Pozo J, Pazos JM, Fonseca E. Lower lip hypertrophy secondary to port-wine stain: combinded surgical and Carbon dioxide laser treatment. Dermatol Surg 2004; 30:211–4.
The Role of Ultrasound in Severity Assessment in Hidradenitis Suppurativa We have read the recent article of Wortsman and colleagues, Ultrasound in-depth characterization and staging of hidradenitis suppurativa1 with great interest. Dr. Wortsman has made significant contributions to the use of ultrasound in dermatology.2 In her recent article, she and her colleagues demonstrated that clinically undetectable but nevertheless substantial changes in dermal and subdermal tissue, such as subclinical fistulae, can be identified only using ultrasound.1 This is a significant discovery because treatment hinges on relevant and accurate disease assessment.
Imaging may provide an appropriate method for this.4 Based on ultrasound findings in HS, the authors modified the disease management in 28 of 34 patients (82%), emphasizing the clinical usefulness of ultrasound examination.1 Wortsman and colleagues’ article therefore strongly suggests that ultrasound provides valuable anatomic information on the extent of HS lesions and should accompany clinical examination to permit more-reliable assessment of disease severity in HS.
References Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the pilosebaceous unit causing painful, suppurating, malodorous skin lesions including inflammatory nodules, abscesses, and sinus tracts.3 The disease is associated with significant morbidity and represents a major therapeutic challenge to clinicians. Therapeutic decisions are based on disease severity, assessed most commonly using the Hurley classification. The more time-consuming Sartorius score might be calculated based on lesion count, but both classification systems have marked limitations because they are based on the mere presence of clinically detectable lesions, are heavily influenced by scar tissue, and therefore have limited sensitivity regarding the present degree of inflammation. There is a need for a more-objective method to classify disease severity to permit reliable stratification of patients in clinical trails and in everyday practice.
1. Wortsman X, Moreno C, Soto R, Arellano J, et al. Ultrasound in-depth characterization and staging of hidradenitis suppurativa. Dermatol Surg 2013;39:1835–42. 2. Wortsman X, Wortsman J. Clinical usefulness of variablefrequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2010;62:247–56. 3. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012;366:158–64. 4. Kelekis NL, Efstathopoulos E, Balanika A, Spyridopoulos TN, et al. Ultrasound aids in diagnosis and severity assessment of hidradenitis suppurativa. Br J Dermatol 2010;162:1400–2.
KIAN ZARCHI, MD GREGOR B. E. JEMEC, MD, DMSC Department of Dermatology Roskilde Hospital Health Science Faculty University of Copenhagen Roskilde, Denmark
Advantages of the Half-Circle Suture Needle for Reconstructing Small Cutaneous Surgical Wounds Dermatologic surgeons use numerous suture types for closing cutaneous wounds. A thorough under-
592
DERMATOLOGIC SURGERY
standing of suture material properties1,2 and needle anatomy (Figure 1) is essential for all dermatologic
CAITRIONA B. HACKETT, MRCPI JAMES A. A. LANGTRY, MBBS, FRCP Department of Dermatology Royal Victoria Infirmary Hospital Newcastle upon Tyne, UK
4. Rajan N, Ryan J, Langtry JAA. Squamous cell carcinoma arising within a facial port-wine stain treated by Mohs micrographic surgical excision. Dermatol Surg 2006;32:864–6. 5. Del Pozo J, Pazos JM, Fonseca E. Lower lip hypertrophy secondary to port-wine stain: combinded surgical and Carbon dioxide laser treatment. Dermatol Surg 2004; 30:211–4.
The Role of Ultrasound in Severity Assessment in Hidradenitis Suppurativa We have read the recent article of Wortsman and colleagues, Ultrasound in-depth characterization and staging of hidradenitis suppurativa1 with great interest. Dr. Wortsman has made significant contributions to the use of ultrasound in dermatology.2 In her recent article, she and her colleagues demonstrated that clinically undetectable but nevertheless substantial changes in dermal and subdermal tissue, such as subclinical fistulae, can be identified only using ultrasound.1 This is a significant discovery because treatment hinges on relevant and accurate disease assessment.
Imaging may provide an appropriate method for this.4 Based on ultrasound findings in HS, the authors modified the disease management in 28 of 34 patients (82%), emphasizing the clinical usefulness of ultrasound examination.1 Wortsman and colleagues’ article therefore strongly suggests that ultrasound provides valuable anatomic information on the extent of HS lesions and should accompany clinical examination to permit more-reliable assessment of disease severity in HS.
References Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the pilosebaceous unit causing painful, suppurating, malodorous skin lesions including inflammatory nodules, abscesses, and sinus tracts.3 The disease is associated with significant morbidity and represents a major therapeutic challenge to clinicians. Therapeutic decisions are based on disease severity, assessed most commonly using the Hurley classification. The more time-consuming Sartorius score might be calculated based on lesion count, but both classification systems have marked limitations because they are based on the mere presence of clinically detectable lesions, are heavily influenced by scar tissue, and therefore have limited sensitivity regarding the present degree of inflammation. There is a need for a more-objective method to classify disease severity to permit reliable stratification of patients in clinical trails and in everyday practice.
1. Wortsman X, Moreno C, Soto R, Arellano J, et al. Ultrasound in-depth characterization and staging of hidradenitis suppurativa. Dermatol Surg 2013;39:1835–42. 2. Wortsman X, Wortsman J. Clinical usefulness of variablefrequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2010;62:247–56. 3. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012;366:158–64. 4. Kelekis NL, Efstathopoulos E, Balanika A, Spyridopoulos TN, et al. Ultrasound aids in diagnosis and severity assessment of hidradenitis suppurativa. Br J Dermatol 2010;162:1400–2.
KIAN ZARCHI, MD GREGOR B. E. JEMEC, MD, DMSC Department of Dermatology Roskilde Hospital Health Science Faculty University of Copenhagen Roskilde, Denmark
Advantages of the Half-Circle Suture Needle for Reconstructing Small Cutaneous Surgical Wounds Dermatologic surgeons use numerous suture types for closing cutaneous wounds. A thorough under-
592
DERMATOLOGIC SURGERY
standing of suture material properties1,2 and needle anatomy (Figure 1) is essential for all dermatologic
