Clinical Report: Expanding the Concept of Active Tunnels in Hidradenitis Suppurativa

Overview

This study highlights that current definitions of active tunnels in hidradenitis suppurativa (HS) may overlook significant inflammatory activity in non-draining lesions. High-frequency colour Doppler ultrasound reveals persistent vascular activity in these tunnels, suggesting a need for revised clinical criteria for identifying active disease.

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can lead to severe morbidity due to recurrent lesions and tissue damage. Traditional assessments often equate tunnel activity with purulent drainage, potentially missing early inflammatory changes in non-draining tunnels. Recognizing these changes is crucial for timely intervention and improved patient outcomes.

Data Highlights

Key Findings

• High-frequency Doppler ultrasound is effective in identifying vascular activity in non-draining tunnels, which may indicate active disease.

• Traditional definitions of active tunnels may miss significant inflammatory activity, leading to delayed treatment.

• Limitations of Doppler ultrasound include potential operator dependency and the need for specialized training to interpret results accurately.

Clinical Implications

Healthcare professionals should consider incorporating high-frequency ultrasound into routine assessments of HS to better identify active inflammation. Recognizing non-draining tunnels as potentially active may lead to earlier and more effective treatment strategies.

Conclusion

This study advocates for a broader definition of active tunnels in HS, emphasizing the importance of objective imaging in recognizing inflammatory activity. Adapting clinical criteria could enhance patient management and outcomes.

Related Resources & Content

1. Frontiers in Immunology, 2026 -- Meta-inflammation in Hidradenitis Suppurativa

2. JAMA Dermatology, 2023 -- Lutikizumab in Adults With Moderate to Severe Hidradenitis Suppurativa

3. Dermatology and Therapy, 2026 -- The Role of Inflammatory Biomarkers in Disease Severity

4. S2k guideline for the treatment of hidradenitis suppurativa, 2024

5. PubMed, 2023 -- Secukinumab in moderate-to-severe hidradenitis suppurativa

6. Frontiers in Immunology — Differentiation defects reposition sebaceous glands as inflammatory instigators in the early pathogenesis of hidradenitis suppurativa

7. International consensus statement on the use of ultrasound in hidradenitis suppurativa

8. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa – Short version - Zouboulis - 2024 - JDDG: Journal der Deutschen Dermatologischen Gesellschaft - Wiley Online Library

9. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials - PubMed