Can High-Frequency Ultrasonography Revolutionize Dermatological Diagnostics?

🔍 Key Finding High-frequency ultrasonography (HFUS) is a valuable non-invasive tool for visualizing and measuring skin lesions in various dermatological conditions, aiding in diagnosis, assessment of disease severity, and monitoring treatment response. Distinct HFUS image characteristics were observed for various skin conditions, including verruca vulgaris, epidermoid cysts, morphea, lichen sclerosus, progressive systemic sclerosis, maculopapular cutaneous mastocytosis, melanoma, non-melanoma skin cancer, atopic dermatitis, psoriasis, hidradenitis suppurativa, and cutaneous T-cell lymphoma.

🔬 Methodology Overview

• Design: Retrospective study and literature review.
• Data Sources: Empirical investigations using HFUS and a systematic review of literature in PubMed.
• Search Terms: “dermatology” AND “HFUS” and “HFUS”.
• Study Focus: HFUS images of various dermatological conditions and procedures in aesthetic medicine.
• Data Collection: Sonographic examinations performed using a Taberna pro medicum GmbH (tpm) device (Lüneburg, Germany) with a 22.5 MHz transducer.
• Analysis Approach: Qualitative description and comparison of sonographic features observed in normal skin and various skin lesions.
• Scope: Diagnostic utility of HFUS in dermatology, including diagnosis, evaluation, monitoring, and remission assessment.

📊 Results

• Verruca vulgaris: Complete acoustic shadowing of epidermal structures on lesion surface.
• Epidermoid cyst: Distinct echogenicity patterns; highest above cyst, intermediate in adjacent skin, lowest above cyst wall.
• Morphea: Hyperechoic echo in entry zone; dermal band expands in inflammatory stage, constricts in fibrotic stage.
• Lichen sclerosus et atrophicus: Hyperechoic, expanded, and sinuous resonance within the introductory zone. Subepidermal echo-lucent band up to 1.2 mm thick (in one case).
• Maculopapular cutaneous mastocytosis: Two sonographic profiles: (1) increased dermal hypoechogenicity indicating mast cell infiltration, (2) fusiform subepidermal configuration suggesting cellular infiltration. Patients with the second profile showed better response to PUVA therapy.
• Sclerotic dermatoses (morphea, PSS, cGvHD): HFUS showed increased vascularity in morphea, dermal thickening and hypoechogenicity in PSS, and dermal thickening, blurred dermal-hypodermal junction, and panniculitis (80%) and increased vascularity (70%) in cGvHD. Discrepancy between clinical and HFUS assessment of disease activity in 23.6% of cases, leading to treatment adjustments in 19.4%.
• Atopic dermatitis: Hypoechoic band present in 93.7% of patients. Thickness of band correlated with epidermal hyperplasia, hyperkeratosis, parakeratosis, spongiosis, and inflammatory infiltrate intensity. Inverse relationship between skin echogenicity and inflammatory infiltrate intensity. Significant reduction in SLEB thickness observed in patients treated with tacrolimus (54.6% of initial 39 patients completed the study).
• Psoriasis vulgaris: Amplified and heightened echogenicity of entry zone with hypoechogenic area in upper dermis of active plaques. These features diminished with phototherapy. Significant reduction in PASI score (85% with calcipotriol/betamethasone, 82% with NB-UVB) and SLEB thickness with both treatments.
• Cutaneous T-cell lymphoma (CTCL): Variations in hydration, pH, melanin content, and erythema index between lesions and unaffected skin. Decreased dermal echo density in CTCL lesions. Reduced SLEB thickness after phototherapy. Increased epidermal thickness compared to atopic dermatitis. Dermal infiltration and increased dermal thickness in Sézary syndrome.

💡 Clinical Impact High-frequency ultrasonography (HFUS) offers a non-invasive, repeatable, and safe method for objective 3D assessment of skin lesions, aiding diagnosis, disease severity evaluation, treatment monitoring, and remission assessment. HFUS may become as ubiquitous as dermatoscopes, expediting diagnoses, guiding treatment decisions, and improving patient outcomes by providing real-time, detailed imaging of skin pathologies.

🤔 Limitations

• Lower resolution images compared to electromagnetic wave imaging.
• Epidermis assessed indirectly as the entry zone.
• Subcutaneous tissue evaluated only at the dermal-subcutaneous interface.
• HFUS alone does not provide a definitive diagnosis.
• Extensive training and experience needed for accurate skin evaluation.

✨ What It Means For You High-frequency ultrasonography (HFUS) offers dermatologists a non-invasive, cost-effective tool to visualize and measure skin lesions, aiding in diagnosis, disease severity assessment, and treatment monitoring. This readily available imaging technique can improve diagnostic accuracy and personalize treatment strategies for various dermatological conditions, including melanoma, psoriasis, and cutaneous T-cell lymphoma.

Reference Cisoń H, Białynicki-Birula R. High-frequency ultrasonography: one of the modern imaging diagnostic methods in dermatology. Authors’ own experience and review. Advances in Dermatology and Allergology. 2024;XLI(3):306-313. https://doi.org/10.5114/ada.2024.141108