Ultrasound of Common Inflammatory Dermatologic Diseases

  • Ximena WortsmanEmail author


The use of ultrasound can be beneficial in the diagnosis of many inflammatory dermatologic diseases, some of which can be devastating for the quality of life of individuals. This chapter reviews the sonographic characteristics of common inflammatory diseases, with emphasis on the description of ultrasound patterns.


Hematoma ultrasound Seroma ultrasound Abscess ultrasound Edema ultrasound Lymphedema ultrasound Panniculitis ultrasound Morphea ultrasound Cutaneous lupus ultrasound Dermatomyositis ultrasound Psoriasis ultrasound Nail psoriasis ultrasound Acne ultrasound Hidradenitis ultrasound Foreign bodies ultrasound 

Supplementary material

Video 9.1

Abscess (see Fig. 9.2b) (MP4 3439 kb)

Video 9.2

Acne (see Fig. 9.28d) (MP4 3173 kb)

Video 9.3

Hidradenitis Supppurativa multiple and communicating fistulous tracts. Ultrasound (greyscale; transverse view; right axillary region) demonstrates three adjacent and communicating hypoechoic fistulous tracts in cross-sectional view going from cephalad to caudal in the axillary region (see Fig. 9.37) (MP4 3148 kb)


  1. 1.
    Wortsman X, Carreño L, Morales C. Inflammatory diseases of the skin. In: Wortsman X, Jemec GBE, editors. Dermatologic ultrasound with clinical and histologic correlations. New York: Springer; 2013. p. 73–117.CrossRefGoogle Scholar
  2. 2.
    McKenzie G, Raby N, Ritchie D. Pictorial review: non-neoplastic soft-tissue masses. Br J Radiol. 2009;82:775–85.CrossRefPubMedGoogle Scholar
  3. 3.
    Le CK, Harvey G, McLean L, Fischer J. Point-of-care ultrasound use to differentiate hematoma and sarcoma of the thigh in the pediatric emergency department. Pediatr Emerg Care. 2017;33:135–6.PubMedGoogle Scholar
  4. 4.
    Loyer EM, DuBrow RA, David CL, Coan JD, Eftekhari F. Imaging of superficial soft-tissue infections: sonographic findings in cases of cellulitis and abscess. AJR Am J Roentgenol. 1996;166:149–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Adhikari S, Blaivas M. Sonography first for subcutaneous abscess and cellulitis evaluation. J Ultrasound Med. 2012;31:1509–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Subramaniam S, Bober J, Chao J, Zehtabchi S. Point-of-care ultrasound for diagnosis of abscess in skin and soft tissue infections. Acad Emerg Med. 2016;23:1298–306.CrossRefPubMedGoogle Scholar
  7. 7.
    Gaspari RJ, Sanseverino A. Ultrasound-guided drainage for pediatric soft tissue abscesses decreases clinical failure rates compared to drainage without ultrasound: a retrospective study. J Ultrasound Med. 2017;37(1):131–6. Scholar
  8. 8.
    O’Donnell TF Jr, Rasmussen JC, Sevick-Muraca EM. New diagnostic modalities in the evaluation of lymphedema. J Vasc Surg Venous Lymphat Disord. 2017;5:261–73.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Requena L, Yus ES. Panniculitis. Part I. Mostly septal panniculitis. J Am Acad Dermatol. 2001;45:163–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Requena L, Sánchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol. 2001;45:325–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Wortsman X. Sonography of dermatologic emergencies. J Ultrasound Med. 2017;36:1905–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Maldonado Cid P, Rubio Flores C, Prats Caelles I, Leis Dosil VM, Alfageme Roldán F, et al. High-frequency ultrasound features in a case of gouty panniculitis. Dermatol Online J. 2017;23(6):9.Google Scholar
  13. 13.
    Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. 2013;27:391–404.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gualtierotti R, Ingegnoli F, Griffini S, Grovetti E, Borghi MO, Bucciarelli P, et al. Detection of early endothelial damage in patients with Raynaud's phenomenon. Microvasc Res. 2017;113:22–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Marvi U, Chung L, Fiorentino DF. Clinical presentation and evaluation of dermatomyositis. Indian J Dermatol. 2012;57:375–81.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Fett NM. Morphea (localized scleroderma). JAMA Dermatol. 2013;149:1124.CrossRefPubMedGoogle Scholar
  17. 17.
    Fett N, Werth VP. Update on morphea: part II. Outcome measures and treatment. J Am Acad Dermatol. 2011;64:231–42.CrossRefPubMedGoogle Scholar
  18. 18.
    Peterson LS, Nelson AM, Su WP. Classification of morphea (localized scleroderma). Mayo Clin Proc. 1995;70:1068–76.CrossRefPubMedGoogle Scholar
  19. 19.
    Bielsa Marsol I. Update on the classification and treatment of localized scleroderma. Actas Dermosifiliogr. 2013;104:654–66.CrossRefPubMedGoogle Scholar
  20. 20.
    Li SC, Liebling MS, Haines KA. Ultrasonography is a sensitive tool for monitoring localized scleroderma. Rheumatology (Oxford). 2007;46:1316–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Wortsman X, Wortsman J, Sazunic I, Carreño L. Activity assessment in morphea using color Doppler ultrasound. J Am Acad Dermatol. 2011;65:942–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Li SC, Liebling MS, Haines KA, Weiss JE, Prann A. Initial evaluation of an ultrasound measure for assessing the activity of skin lesions in juvenile localized scleroderma. Arthritis Care Res (Hoboken). 2011;63:735–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Wortsman X, Ma L, Chung WK, Wortsman J. Evaluation of the CAV1 gene in clinically, sonographically and histologically proven morphea patients. Exp Dermatol. 2015;24:718–20.CrossRefPubMedGoogle Scholar
  24. 24.
    Porta F, Kaloudi O, Garzitto A, Prignano F, Nacci F, Falcini F, Matucci Cerinic M. High frequency ultrasound can detect improvement of lesions in juvenile localized scleroderma. Mod Rheumatol. 2014;24:869–73.CrossRefPubMedGoogle Scholar
  25. 25.
    Wang L, Yan F, Yang Y, Xiang X, Qiu L. Quantitative assessment of skin stiffness in localized scleroderma using ultrasound shear-wave elastography. Ultrasound Med Biol. 2017;43:1339–47.CrossRefPubMedGoogle Scholar
  26. 26.
    Wortsman X, Holm EA, Jemec GBE, Gniadecka M. Wulf HC. 15 MHz high-resolution ultrasound examination of psoriatic nails. Revista Chilena de Radiología. 2004;10:6–9. (Spanish)CrossRefGoogle Scholar
  27. 27.
    Gutierrez M, Wortsman X, Filippucci E, De Angellis R, Filosa G, Grassi W. High frequency sonography in the evaluation of psoriasis: nail and skin involvement. J Ultrasound Med. 2009;28:1569–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Wortsman X, Gutierrez M, Saavedra T, Honeyman J. The role of ultrasound in rheumatic skin and nail lesions: a multi-specialist approach. Clin Rheumatol. 2011;30:739–48.CrossRefPubMedGoogle Scholar
  29. 29.
    Gutierrez M, Filippucci E, Bertolazzi C, Grassi W. Sonographic monitoring of psoriatic plaque. J Rheumatol. 2009;36:850–1.CrossRefPubMedGoogle Scholar
  30. 30.
    Gutierrez M, Filippucci E, De Angelis R, Filosa G, Kane D, Grassi W. A sonographic spectrum of psoriatic arthritis: “the five targets”. Clin Rheumatol. 2010;29:133–42.CrossRefPubMedGoogle Scholar
  31. 31.
    Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, et al. Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxford). 2012;51:1261–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Sandobal C, Carbó E, Iribas J, Roverano S, Paira S. Ultrasound nail imaging on patients with psoriasis and psoriatic arthritis compared with rheumatoid arthritis and control subjects. J Clin Rheumatol. 2014;20:21–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Castellanos-González M, Joven BE, Sánchez J, Andrés-Esteban EM, Vanaclocha-Sebastián F, Romero PO, Díaz RR. Nail involvement can predict enthesopathy in patients with psoriasis. J Dtsch Dermatol Ges. 2016;14:1102–7.PubMedGoogle Scholar
  34. 34.
    Mathew AJ, Coates LC, Danda D, Conaghan PG. Psoriatic arthritis: lessons from imaging studies and implications for therapy. Expert Rev Clin Immunol. 2017;13:133–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Michelsen B, Diamantopoulos AP, Hammer HB, Soldal DM, Kavanaugh A, Haugeberg G. Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity. Ann Rheum Dis. 2016;75:2108–13.CrossRefPubMedGoogle Scholar
  36. 36.
    Wortsman X, Soto R. Ultrasound imaging of psoriatic nails. In: Rigopoulos D, Tosti A, editors. Nail psoriasis: From A to Z. New York: Springer; 2015. p. 57–64.Google Scholar
  37. 37.
    Thomas L, Vaudaine M, Wortsman X, Jemec GBE, Drapé JL. Imaging the nail unit. In: Baran R, de Berker D, Holzberg M, Thomas L, editors. Baran and Dawber’s diseases of the nails and their management. 4th ed. Oxford: Blackwell Publishing; 2012. p. 132–153.Google Scholar
  38. 38.
    Wortsman X. Sonography of the nail. In: Wortsman X, Jemec GBE, editors. Dermatologic ultrasound with clinical and histologic correlations. New York: Springer; 2013. p. 419–76.CrossRefGoogle Scholar
  39. 39.
    Vidal D, Alfageme F, Ruiz-Villaverde R, Arias-Santiago S, Martorell A. Ultrasound characterization of psoriasis of the nails: a case-control study. Actas Dermosifiliogr. 2017;108:968–9.CrossRefPubMedGoogle Scholar
  40. 40.
    De Agustín JJ, Moragues C, De Miguel E, Möller I, Acebes C, Naredo E, et al. A multicentre study on high-frequency ultrasound evaluation of the skin and joints in patients with psoriatic arthritis treated with infliximab. Clin Exp Rheumatol. 2012;30:879–85.PubMedGoogle Scholar
  41. 41.
    Naredo E, Möller I, de Miguel E, Batlle-Gualda E, Acebes C, Brito E, Ultrasound School of the Spanish Society of Rheumatology and Spanish ECO-APs Group, et al. High prevalence of ultrasonographic synovitis and enthesopathy in patients with psoriasis without psoriatic arthritis: a prospective case-control study. Rheumatology (Oxford). 2011;50:1838–48.CrossRefPubMedGoogle Scholar
  42. 42.
    Freeston JE, Coates LC, Nam JL, Moverley AR, Hensor EM, Wakefield RJ, et al. Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care Res (Hoboken). 2014;66:432–9.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Zouboulis CC, Eady A, Philpott M, Goldsmith LA, Orfanos C, Cunliffe WC, Rosenfield R. What is the pathogenesis of acne? Exp Dermatol. 2005;14:143–52.CrossRefPubMedGoogle Scholar
  44. 44.
    Suh DH, Kwon HH. What's new in the physiopathology of acne? Br J Dermatol. 2015;172(Suppl 1):13–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Wortsman X, Claveria P, Valenzuela F, Molina MT, Wortsman J. Sonography of acne vulgaris. J Ultrasound Med. 2014;33:93–102.CrossRefPubMedGoogle Scholar
  46. 46.
    Lacarrubba F, Verzì AE, Tedeschi A, Catalfo P, Nasca MR, Micali G. Clinical and ultrasonographic correlation of acne scars. Dermatol Surg. 2013;39:1683–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012;366:158–64.CrossRefPubMedGoogle Scholar
  48. 48.
    Miller IM, McAndrew RJ, Hamzavi I. Prevalence, risk factors, and comorbidities of hidradenitis suppurativa. Dermatol Clin. 2016;34:7–16.CrossRefPubMedGoogle Scholar
  49. 49.
    Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2009;23:985–98.CrossRefPubMedGoogle Scholar
  50. 50.
    Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa and familial benign pemphigus: surgical approach. In: Roenigk RK, Roenigk HH, editors. Dermatologic surgery. New York: Marcel Dekker; 1989. p. 729–39.Google Scholar
  51. 51.
    Jemec GB, Gniadecka M. Ultrasound examination of hair follicles in hidradenitis suppurativa. Arch Dermatol. 1997;133:967–70.CrossRefPubMedGoogle Scholar
  52. 52.
    Kelekis NL, Efstathopoulos E, Balanika A, Spyridopoulos TN, Pelekanou A, Kanni T, et al. Ultrasound aids in diagnosis and severity assessment of hidradenitis suppurativa. Br J Dermatol. 2010;162:1400–2.CrossRefPubMedGoogle Scholar
  53. 53.
    Wortsman X, Jemec GBE. High frequency ultrasound for the assessment of hidradenitis suppurativa. Dermatol Surg. 2007;33:1–3.Google Scholar
  54. 54.
    Wortsman X, Revuz J, Jemec GBE. Lymph nodes in hidradenitis suppurativa. Dermatology. 2009;219:32–41.CrossRefGoogle Scholar
  55. 55.
    Wortsman X, Jemec G. A 3D ultrasound study of sinus tract formation in hidradenitis suppurativa. Dermatol Online J. 2013;19:18564.PubMedGoogle Scholar
  56. 56.
    Zarchi K, Yazdanyar N, Yazdanyar S, Wortsman X, Jemec GB. Pain and inflammation in hidradenitis suppurativa correspond to morphological changes identified by high-frequency ultrasound. J Eur Acad Dermatol Venereol. 2015;29:527–32.CrossRefPubMedGoogle Scholar
  57. 57.
    Wortsman X, Moreno C, Soto R, Arellano J, Pezo C, Wortsman J. Ultrasound in-depth characterization and staging of hidradenitis suppurativa. Dermatol Surg. 2013;39:1835–42.CrossRefPubMedGoogle Scholar
  58. 58.
    Martorell A, Segura Palacios JM. Ultrasound examination of hidradenitis suppurativa. Actas Dermosifiliogr. 2015;106(Suppl 1):49–59.CrossRefPubMedGoogle Scholar
  59. 59.
    Wortsman X, Wortsman J. Ultrasound detection of retained hair tracts in hidradenitis suppurativa. Dermatol Surg. 2015;41:867–9.CrossRefPubMedGoogle Scholar
  60. 60.
    Wortsman X, Rodriguez C, Lobos C, Eguiguren G, Molina MT. Ultrasound diagnosis and staging in pediatric hidradenitis suppurativa. Pediatr Dermatol. 2016;33(4):e260.CrossRefPubMedGoogle Scholar
  61. 61.
    Wortsman X. Imaging of hidradenitis suppurativa. Dermatol Clin. 2016;34:59–68.CrossRefPubMedGoogle Scholar
  62. 62.
    Wortsman X, Castro A, Figueroa A. Color Doppler ultrasound assessment of morphology and types of fistulous tracts in hidradenitis suppurativa (HS). J Am Acad Dermatol. 2016;75:760–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Wortsman X. Reply to Lipsker et al. and Revuz on hidradenitis suppurativa terminology: the imaging point of view. Dermatology. 2016;232:507.CrossRefGoogle Scholar
  64. 64.
    Martorell A, Wortsman X, Alfageme F, Roustan G, Arias-Santiago S, Catalano O, et al. Ultrasound evaluation as a complementary test in hidradenitis suppurativa: proposal of a standarized report. Dermatol Surg. 2017;43:1065–73.CrossRefPubMedGoogle Scholar
  65. 65.
    Wortsman X, Castro A, Morales C, Franco C, Figueroa A. sonographic comparison of morphologic characteristics between pilonidal cysts and hidradenitis suppurativa. J Ultrasound Med. 2017;36:2403–18.CrossRefPubMedGoogle Scholar
  66. 66.
    Lee EY, Kang JY, Kim KW, Choi KH, Yoon TY, Lee JY. Clinical characteristics of odontogenic cutaneous fistulas. Ann Dermatol. 2016;28:417–21.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Garrido Colmenero C, Blasco Morente G, Latorre Fuentes JM, Ruiz Villaverde R. Diagnostic value of color Doppler ultrasound for cutaneous odontogenic sinus tract. Actas Dermosifiliogr. 2015;106:678–80.CrossRefPubMedGoogle Scholar
  68. 68.
    Boyse TD, Fessell DP, Jacobson JA, Lin J, van Holsbeeck MT, Hayes CW. US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics. 2001;21:1251–6.CrossRefPubMedGoogle Scholar
  69. 69.
    Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med. 2013;32:1443–50.CrossRefPubMedGoogle Scholar
  70. 70.
    Tahmasebi M, Zareizadeh H, Motamedfar A. Accuracy of ultrasonography in detecting radiolucent soft-tissue foreign bodies. Indian J Radiol Imaging. 2014;24:196–200.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Soudack M, Nachtigal A, Gaitini D. Clinically unsuspected foreign bodies: the importance of sonography. J Ultrasound Med. 2003;22:1381–5.CrossRefPubMedGoogle Scholar
  72. 72.
    Wortsman X. Common applications of dermatologic sonography. J Ultrasound Med. 2012;31:97–111.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.IDIEPInstitute for Diagnostic Imaging and Research of the Skin and Soft TissuesSantiagoChile
  2. 2.Department of DermatologyUniversidad de ChileSantiagoChile
  3. 3.Department of DermatologyPontificia Universidad Católica de ChileSantiagoChile

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