Ultrasonography > Volume 42(3); 2023 > Article
Mese: Expanding dermatologic ultrasonography applications: further insights for enhanced patient management
I recently read the enlightening article "Top applications of dermatologic ultrasonography that can modify management" [1] in your esteemed journal, Ultrasonography. I would like to commend the authors for their excellent work in highlighting the significant advances and potential applications of dermatologic ultrasonography.
As a radiologist, I have witnessed the rapid expansion of ultrasonography in dermatologic practice over the last decade. In addition to the applications mentioned in the article, I would like to highlight some other important uses of dermatologic ultrasonography that further underscore its value in dermatologic practice.
Cellulitis is a bacterial infection of the skin and subcutaneous tissue, commonly caused by Staphylococcus aureus and Streptococcus pyogenes. Ultrasonography can show diffuse thickening of the dermis and subcutaneous tissue, with increased echogenicity and a "cobblestone" appearance. Color Doppler may reveal increased blood flow in the affected area [2].
Lipomas are benign fatty tumors that present as soft, mobile, and painless masses. Ultrasonography can show a well-defined, oval, or round hyperechoic mass, with fine internal echoes and posterior acoustic enhancement. Lipomas are typically homogeneous and compressible [3].
Abscesses are collections of pus within a confined space, usually caused by bacterial infection. Ultrasonography can display an irregular, hypoechoic or anechoic mass with variable echogenic debris, surrounded by a hyperechoic rim. Color Doppler may reveal increased peripheral vascularity [4].
Hematomas are localized collections of blood outside blood vessels, caused by trauma or coagulopathy. Ultrasonography can reveal a hypoechoic or heterogeneous mass, which may become more hyperechoic and organized over time as the blood clots. They can mimic superficial soft tissue tumors [5].
Lymphedema is swelling caused by a blockage in the lymphatic system, leading to an accumulation of lymphatic fluid. Ultrasonography can show thickening and increased echogenicity of the subcutaneous tissue, with a honeycomb pattern. Dilated lymphatic channels may also be observed [6].
Foreign bodies are objects or substances lodged within the skin or subcutaneous tissue, often as a result of trauma or injury. Ultrasonography can help visualize foreign bodies such as wood, glass, or metal, which appear as hyperechoic structures with posterior acoustic shadowing. Surrounding inflammation and possible abscess formation may also be observed [7].
Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei. High-resolution ultrasonography can help identify the mites as hyperechoic, millimetric structures within the epidermis, and their burrows as linear or curvilinear hypoechoic tracks in the stratum corneum [8].
Warts are benign skin growths caused by human papillomavirus infection. Ultrasonography can display warts as a hypoechoic or heterogeneous mass, with irregular thickening of the epidermis and dermis, and increased vascularity on Doppler examination [9].
Psoriasis is a chronic autoimmune skin condition characterized by red, scaly plaques. Ultrasonography can show thickening of the epidermis, increased dermal echogenicity, and a prominent hypoechoic band representing the inflammation within the dermis. Color Doppler may show increased blood flow in the affected area [10].
In conclusion, dermatologic ultrasonography is a valuable tool for managing skin conditions.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

References

1. Wortsman X. Top applications of dermatologic ultrasonography that can modify management. Ultrasonography 2023;42:183–202.
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2. O'Rourke K, Kibbee N, Stubbs A. Ultrasound for the evaluation of skin and soft tissue infections. Mo Med 2015;112:202–205.
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3. Rahmani G, McCarthy P, Bergin D. The diagnostic accuracy of ultrasonography for soft tissue lipomas: a systematic review. Acta Radiol Open 2017;6:2058460117716704.
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4. 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;23:1298–1306.
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5. Ryu JK, Jin W, Kim GY. Sonographic appearances of small organizing hematomas and thrombi mimicking superficial soft tissue tumors. J Ultrasound Med 2011;30:1431–1436.
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6. Johnson KC, DeSarno M, Ashikaga T, Dee J, Henry SM. Ultrasound and clinical measures for lymphedema. Lymphat Res Biol 2016;14:8–17.
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7. Marin-Diez E, Landeras Alvaro RM, Lamagrande Obregon A, Pelaz Esteban M, Gallardo Agromayor E. Ultrasonography of subcutaneous foreign bodies: differences depending on their nature, complications, and potential diagnostic errors. Radiologia (Engl Ed) 2020;62:3–12.
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8. Dominguez-Santas M, Roustan-Gullon G, Alfageme-Roldan F. Sonographic findings in scabies. J Ultrasound 2023;26:549–551.
crossref pmid pdf
9. Wortsman X, Sazunic I, Jemec GB. Sonography of plantar warts: role in diagnosis and treatment. J Ultrasound Med 2009;28:787–793.
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10. De Simone C, Caldarola G, D'Agostino M, Carbone A, Guerriero C, Bonomo L, et al. Usefulness of ultrasound imaging in detecting psoriatic arthritis of fingers and toes in patients with psoriasis. Clin Dev Immunol 2011;2011:390726.
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