articulo que habla de ultrasonido de piel

1. 0001-7310/© 2015 Elsevier España, S.L.U. y AEDV. Todos los derechos reservados.
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Ecografía de la hidradenitis supurativa
A. Martorella,
* y J.M. Segura Palaciosb
a
Servicio de Dermatología, Hospital de Manises, Valencia, España
b
Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
PALABRAS CLAVE
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Ultrasound examination of hidradenitis suppurativa
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Nqu"tguwnvcfqu"qdvgpkfqu"rqt"Yqtvuocp."Octvqtgnn"{"Ugiwtc"c"
rctvkt"fg"guvwfkqu"rtqrkqu"fktkikfqu"c"tgcnk¦ct"wp"cpƒnkuku"eqo-
rctcvkxq"gpvtg"nc"guvcfkÞecek„p"en pkec"{"geqitƒÞec"fgn"rc-
ekgpvg"eqp"JU"rgtokvgp"guvcdngegt"wpc"ugtkg"fg"eqpenwukqpgu"
tgngxcpvgu"rctc"uw"ocpglq0
Yqtvuocp"gv"cn"hwgtqp"nqu"rtkogtqu"gp"fguetkdkt"swg"nc"
geqitch c"rgtokvg"xkuwcnk¦ct"eqp"htgewgpekc"ecodkqu"cpcv„-
Tabla 4" GuvcfkÞecek„p"geqitƒÞec"fg"nc"jkftcfgpkvku"uwrwtcvkxc"*UQU/JU+32
Guvcfkq Fguetkrek„p
K Eqngeek„p"n swkfc"¿pkec"{"ecodkqu"ffitokequ"*p„fwnqu"ugwfqsw uvkequ"jkrq"q"cpgeqkequ."gpucpejcokgpvq"fg"nqu"
hqn ewnqu"rknququ."cnvgtcekqpgu"gp"gn"gurguqt"q"geqigpkekfcf"ffitokec+"swg"chgevcp"c"wp"¿pkeq"ugiogpvq"
eqtrqtcn"*wpk"q"dkncvgtcn+"ukp"vtcevqu"Þuvwnququ
KK Fg"4"c"6"eqngeekqpgu"n swkfcu"q"wp"¿pkeq"vtc{gevq"Þuvwnquq"eqp"ecodkqu"ffitokequ"swg"chgevc"jcuvc"4"
ugiogpvqu"eqtrqtcngu"*wpk"q"dkncvgtcn+
KKK Ekpeq"q"oƒu"eqngeekqpgu"n swkfcu"q"4"q"oƒu"vtc{gevqu"Þuvwnququ"eqp"ecodkqu"ffitokequ"q"rctvkekrcek„p"fg"5"q"
oƒu"ugiogpvqu"eqtrqtcngu"*wpk"q"dkncvgtcn+
Figura 5 C+"Jkftcfgpkvku"uwrwtcvkxc"itcxg"chgevcpfq"pcnic"{"owunq0"D+"Fgtoku"gpitqucfc"{"jgvgtqgeqkec"eqp"ƒtgcu"fg"Þdtquku"{"
rtgugpekc"fg"vtcevqu"Þuvwnququ"swg"fkugecp"gn"vglkfq"uwdewvƒpgq0"E+"Fqrrngt"tgxgnc"korqtvcpvg"cevkxkfcf"kpàcocvqtkc0
A C
B

6. 76" C0"Octvqtgnn"{"L0O0"Ugiwtc"Rcncekqu
gp"nqu"guvwfkqu"rtgxkqu."ug"gpeqpvt„"wpc"uwdguvkocek„p"gp"nc"
encukÞecek„p"Jwtng{"tgurgevq"c"nc"encukÞecek„p"UQU/JU."eqp-
etgvcogpvg"gp"wp"44'"fg"nqu"rcekgpvgu"*:158+"*Þi0"9+0"Cfg-
oƒu."gp"wp"47'"ug"oqfkhke„"gn"ocpglq"fg"ofifkeq"c"
swkt¿tikeq"vtcu"nc"tgcnk¦cek„p"fg"nc"geqitch c."ekhtc"ukoknct"cn"
guvwfkq"tghgtkfq"fg"Yqtvuocp32
0
C"rctvkt"fg"nqu"tguwnvcfqu"qdvgpkfqu"gp"nqu"5"vtcdclqu"rtg-
xkcogpvg"eqogpvcfqu"rqfgoqu"eqpenwkt"swg"nc"gzrnqtcek„p"
h ukec"ckuncfc"kphtcguvkoc"nc"itcxgfcf"fg"wp"rqtegpvclg"uki-
pkÞecvkxq"fg"rcekgpvgu"eqp"JU0"Rqt"nq"vcpvq."nc"gxcnwcek„p"
geqitƒÞec"tgcnk¦cfc."dkgp"rqt"gn"fgtocv„nqiq"dkgp"rqt"gn"
tcfk„nqiq"eqp"uwÞekgpvgu"eqpqekokgpvqu"gp"geqitch c"ewvƒ-
pgc43
."tguwnvc"kortguekpfkdng"rctc"tgcnk¦ct"wpc"xcnqtcek„p"
tgcn"fgn"rcekgpvg"eqp"JU0"Fkejc"guvcfkÞecek„p"tguwnvctƒ"enc-
xg"rctc"gn"guvcdngekokgpvq"fg"wp"vtcvcokgpvq"cfgewcfq0
Monitori¦aci„n de la respuesta terapfiutica
Monitori¦aci„n general
Nc"kphqtocek„p"igpgtcn"fgn"rcekgpvg"eqp"JU"ug"dcuc"gp"nc"
gxcnwcek„p"fg"4"rctƒogvtqu"uwdlgvkxqu<"gn"fqnqt"{"gn"korcevq"
rukequqekcn0
fg"guvcfkÞecek„p"fg"nc"gphgtogfcf"ewcpfq"ug"kpvtqfweg"nc"
gxcnwcek„p"geqitƒÞec0
Gp"gn"guvwfkq"ug"eqpukfgt„"swg"nc"nguk„p"en pkecogpvg"enc-
ukÞecfc"eqoq"p„fwnq"ug"eqttgurqpfgt c"eqp"nc"kocigp"geq-
itƒÞec"fg"p„fwnq"ugwfqsw uvkeq0"Fg"nc"okuoc"hqtoc."ncu"
ngukqpgu"gngogpvcngu."gn"cdueguq"{"nc"h uvwnc."ug"encukÞectqp"
geqitƒÞecogpvg"eqp"uwu"jqo„pkoqu"eqngeek„p"n swkfc"{"h u-
vwnc"geqitƒÞec."tgurgevkxcogpvg"*Þi0"8+0
Nqu"tguwnvcfqu"qdvgpkfqu"hwgtqp"ow{"ukipkÞecvkxqu0"Cu ."nc"
gxcnwcek„p"en pkec"fgn"rcekgpvg"kphtcguvko„"fg"hqtoc"ukipk-
Þecvkxc"gn"itcfq"fg"itcxgfcf"fg"nc"JU0"Fg"hqtoc"gurge Þec."
eqp"tgurgevq"c"nc"encukÞecek„p"fg"Jwtng{."wp"52'"fg"nqu"ecuqu"
en pkecogpvg"encukÞecfqu"eqoq"guvcfkqu"fg"Jwtng{"KK1KKK."vtcu"
gn"gzcogp"geqitƒÞeq."rcuctqp"c"ugt"wp"64'0"Cfgoƒu."gn"
cpƒnkuku"fg"itcxgfcf"ogfkcpvg"nc"guecnc"JU/RIC"oquvt„"
e„oq."fgufg"gn"rwpvq"fg"xkuvc"en pkeq."nqu"scores"5."6"{"7"
tgrtgugpvcdcp"eqplwpvcogpvg"wp"52'"fg"nqu"ecuqu."okgpvtcu"
swg"vtcu"gn"cpƒnkuku"geqitƒÞeq"guvg"xcnqt"cwogpv„"jcuvc"wp"
79'"*vcdnc"7+0
Rqt"qvtq"ncfq."Ugiwtc"gv"cn42
"tgcnk¦ctqp"wp"guvwfkq"gxcnwcp-
fq"enkpkeqgeqitƒÞecogpvg"c"58"rcekgpvgu"eqp"JU"eqp"wp"vqvcn"
fg"79"ƒtgcu"ngukqpcngu."eqp"gn"qdlgvkxq"fg"cpcnk¦ct"xctkcekqpgu"
gp"uw"guvcfkÞecek„p"{"eqpugewgpvgogpvg"gp"gn"ocpglq"rqu-
vgtkqt"cn"c‚cfkt"gn"gzcogp"geqitƒÞeq0"Fgn"okuoq"oqfq"swg"
Figura 6 Ngukqpgu"en pkeq/geqitƒÞecu"gngogpvcngu"gp"nc"gzrnqtcek„p"fg"nc"jkftcfgpkvku"uwrwtcvkxc0
Nódulo Absceso Fístula
Nódulo
pseudoquístico
Colección líquida Fístula ecográfica
La actividad Doppler
refleja la actividad
inflamatoria en la
hidradenitis
Lesiones elementales

7. Geqitch c"fg"nc"jkftcfgpkvku"uwrwtcvkxc" 77
ectic"kpàcocvqtkc"swg"ug"rtqfweg"gp"cniwpqu"ecuqu"ngu"kork-
fg"tgcnk¦ct"vctgcu"dƒukecu"fgn"f c"c"f c9.:.46
0"Nc"kpàwgpekc"fg"
nc"JU"gp"nc"EFX"ug"gxcn¿c"ogfkcpvg"gn"ewguvkqpctkq"FNSK."
oqfgnq"wpkxgtucnogpvg"cegrvcfq"rctc"ogfkt"nc"tgrgtewuk„p"
rukequqekcn"ugewpfctkc"c"wpc"rcvqnqi c"et„pkec0
Monitori¦aci„n clínica
Nc"oqpkvqtk¦cek„p"en pkec"cevwcnogpvg"cegrvcfc"rqt"eqpugp-
uq"gu"nc"fgÞpkfc"eqoq"tgurwguvc"en pkec"gp"jkftcfgpkvku"uw-
rwtcvkxc"*JkUET+36
0"Oƒu"swg"wp"oqfgnq"fg"encukÞecek„p"gu"wp"
pwgxq"rctƒogvtq"fg"ogfkek„p"fg"nc"tgurwguvc"cn"vtcvcokgpvq"
ofifkeq"rctc"nc"JU."tgekgpvgogpvg"xcnkfcfq."swg"rtgvgpfg"
ewcpvkÞect"nc"itcxgfcf"fg"nc"gphgtogfcf"{"fgvgtokpct"wp"
qdlgvkxq"en pkeq36
0
Gn"JkUET"ug"fgÞpg"eqoq"wpc"tgfweek„p"œ"72'"gp"gn"tg-
ewgpvq"fg"ngukqpgu"kpàcocvqtkcu"*uwoc"fg"cdueguqu"{"p„fw-
nqu"kpàcocvqtkqu"]CP̲+."ukp"kpetgogpvq"gp"gn"p¿ogtq"fg"
cdueguqu"q"h uvwncu"ftgpcpvgu."tgurgevq"c"nc"ukvwcek„p"dcucn"
*vcdnc"5+0
Evaluación del dolor."Wpq"fg"nqu"rtqdngocu"swg"uwhtgp"nqu"
rcekgpvgu"eqp"JU"gu"gn"fqnqt0"Guvg"uwgng"kt"wpkfq"c"nc"rtgugp-
ekc"fg"p„fwnqu"q"cdueguqu"kpàcocvqtkqu"nqecnk¦cfqu"gp"ƒtgcu"
rtqhwpfcu0"Nqu"rcekgpvgu"nq"fguetkdgp"fg"o¿nvkrngu"hqtocu."
eqoq"rqt"glgornq"ugpucek„p"fg"ecnqt."fg"swgoc¦„p."fg"eqo-
rtguk„p."fg"guvtcpiwncokgpvq"fg"nc"¦qpc44
0
Guvg"fqnqt"gp"gn"rcekgpvg"eqp"JU"ug"qdlgvkxc"wucpfq"wpc"
guecnc"xkuwcn"cpcn„ikec."nc"ewcn"ug"jc"wvknk¦cfq"rtgxkcogpvg"
rctc"fgoquvtct"e„oq"guvc"gphgtogfcf"rtgugpvc"wp"fqnqt"
ukipkÞecvkxcogpvg"uwrgtkqt"cn"fg"ewcnswkgt"qvtc"rcvqnqi c"
ewvƒpgc"*r">"2.223+45
0
Evaluación del impacto psicosocial."Guvkiocvk¦cek„p"fgn"
rcekgpvg"eqp"JU0
Nc"JU"rtqfweg"wpc"korqtvcpvg"cnvgtcek„p"gp"ncu"tgncekqpgu"
kpvgtrgtuqpcngu."fg"cwvqguvkoc"{"fg"rgtegrek„p"fg"nc"kocigp"
rgtuqpcn"{"fg"nc"kocigp"r¿dnkec0"Nqu"rcekgpvgu"uwhtgp"nc"fg-
hqtocek„p"h ukec"swg"uwrqpg"nc"kpàcocek„p."nq"ewcn"wpkfq"cn"
qnqt"ocnqnkgpvg"fg"nc"uwrwtcek„p"swg"gokvgp"{"cn"ocpejcfq"
eqpvkpwq"fg"nc"tqrc"jcegp"swg"guvq"tgrgtewvc"fg"hqtoc"nnc-
ocvkxc"gp"uw"ecnkfcf"fg"xkfc"*EFX+0"C"uw"xg¦."nc"gngxcfc"
Tabla 5" Tguwnvcfqu"fgn"guvwfkq"fg"Octvqtgnn"gv"cn3;
GuvcfkÞecek„p Gzcogp"en pkeq"*'+ Gzcogp"geqitƒÞeq"*'+
Jwtng{ Jwtng{"K."92 Jwtng{"K."7:
Jwtng{"KK."47 Jwtng{"KK."55
Jwtng{"KKK."7 Jwtng{"KKK.";
JU/RIC Score"2."2 Score"2."2
Score"3."57 Score"3."42
Score"4."57 Score"4."45
Score"5."47 Score"5."67
Score"6."5 Score"6."9
Score"7."4 Score"7."7
Figura 7 Tguwnvcfqu"fgn"guvwfkq"fg"Ugiwtc"gv"cn42
0
En el 22% de los pacientes (8/36) existió una subestimación en la clasiicación Hurley respecto a la clasiicación SOS-HS
Estadiicación
clínica-Hurley
Estadiicación
clínico-ecográica
(SOS-HS)
70,00%
60,00%
50,00%
40,00%
30,00%
20,00%
10,00%
0,00%
Estadio III
Estadio II
Estadio I

8. 78" C0"Octvqtgnn"{"L0O0"Ugiwtc"Rcncekqu
Gn"rtkogt"hgp„ogpq"swg"ug"rtqfweg"gp"wp"rcekgpvg"eqp"JU"
swg"rtgugpvc"wpc"tgurwguvc"vgtcrfiwvkec"gu"nc"fkuokpwek„p"fg"
nc"cevkxkfcf"kpàcocvqtkc0"Guvg"hgp„ogpq."owejcu"xgegu"en pk-
ecogpvg"korgtegrvkdng."ug"vtcfweg"geqitƒÞecogpvg"gp"wpc"
fkuokpwek„p"q"cwugpekc"fg"cevkxkfcf"Fqrrngt"*Þiu0";"{"32+0
Gp"ecuq"fg"swg"nc"tgurwguvc"vgtcrfiwvkec"ug"ocpvgpic"gp"gn"
vkgorq."ug"eqogp¦ctƒp"c"xgt"ecodkqu"geqitƒÞequ"uwiguvkxqu"
fg"tgrctcek„p"fgn"vglkfq"fc‚cfq"rqt"nc"kpàcocek„p."swg"kp-
enwkt cp"nc"hqtocek„p"fg"jcegu"jkrgt"g"kuqgeqifipkequ"swg"
qewrcp"ncu"ƒtgcu"cpgeqkecu"fg"ncu"eqngeekqpgu"n swkfcu"{"fg"
ncu"h uvwncu0
Gp"guvg"ecuq"tguwnvc"kpvgtgucpvg"gn"ugiwkokgpvq"gurgekcn"fg"
ncu"h uvwncu."{c"swg"wp"rqtegpvclg"korqtvcpvg"fg"guvcu"rwg-
fgp"tguqnxgtug"vqvcnogpvg"eqp"vtcvcokgpvq"ofifkeq"ukp"pgeg-
ukfcf"fg"ektwi c."ogfkcpvg"gn"ocpvgpkokgpvq"fgn"ƒtgc"nkdtg"
fg"kpàcocek„p"*Þi0"32+0
Hkpcnogpvg."gp"nqu"ecuqu"gp"nqu"swg"nc"cevkxkfcf"kpàcocvq-
tkc"jc"ukfq"ow{"kpvgpuc"{"nc"tgurwguvc"vgtcrfiwvkec"hcxqtcdng."
ug"crtgekctƒ"nc"gzkuvgpekc"fg"vcdkswgu"jkrgtgeqifipkequ"rctc-
ngnqu"c"nc"grkfgtoku."eqttgurqpfkgpvgu"eqp"ƒtgcu"fg"ekecvtk-
¦cek„p"tgukfwcn"*Þiu0";E"{"32E+0
Reali¦aci„n de tficnicas invasivas ecoguiadas
en la hidradenitis supurativa
Wpc"fg"ncu"xgpvclcu"oƒu"korqtvcpvgu"fg"nc"geqitch c."fglcp-
fq"c"wp"ncfq"uw"kpqewkfcf."gu"uw"ecrcekfcf"rctc"oquvtct"gp"
vkgorq"tgcn"nc"guvtwevwtc"ewvƒpgc0"Guvq"pqu"rwgfg"ugt"ow{"
¿vkn"gp"nc"crnkecek„p"fg"vfiepkecu"kpxcukxcu."eqp"gn"Þp"fg"qtkgp-
vct"fg"hqtoc"oƒu"gurge Þec"pwguvtc"ceek„p"vgtcrfiwvkec0
Gp"guvg"ugpvkfq."wpc"fg"ncu"rtkpekrcngu"vfiepkecu"tgcnk¦cfcu"
gp"gn"rcekgpvg"eqp"JU"gu"nc"kpÞnvtcek„p"fg"cegv„pkfq"fg"
vtkcoekpqnqpc"*62"oi1on+"q"dgvcogvcuqpc"*5"oi1on+"gp"ncu"
ngukqpgu"rtqdngoc"*Þi0"33+0"Gp"guvg"ecuq."nc"geqitch c"pqu"
rgtokvktƒ"cugiwtct"nc"kp{geek„p"fgn"ogfkecogpvq"gp"nc"¦qpc"
rcvqn„ikec"{"gxkvct"fc‚ct"guvtwevwtcu"cf{cegpvgu0
Fg"guvg"oqfq."gn"vtcvcokgpvq"geqiwkcfq"rgtokvg"cnecp¦ct"
nc"tgurwguvc"eqorngvc"fg"wpc"nguk„p"eqp"wpc"rtqdcdknkfcf"
uwrgtkqt"htgpvg"c"nc"crnkecek„p"fg"nc"vfiepkec"c"ekgicu0
Gn"JkUET"gu."rqt"nq"vcpvq."wp"qdlgvkxq"en pkeq"swg"ug"dcuc"
gp"gn"tgewgpvq"vqvcn"fg"ngukqpgu"kpàcocvqtkcu"swg"rtgugp-
vc"wp"rcekgpvg"chgevcfq"fg"JU"gp"wp"oqogpvq"fgvgtokpc-
fq0"Fg"guvc"hqtoc"ug"rwgfg"fgÞpkt"vcodkfip"gn"rqtegpvclg"
fg"tgfweek„p"fg"cdueguqu"{"p„fwnqu"kpàcocvqtkqu"tgurgevq"
c"dcucn<"CP72."CP97"{"CP322"*tgfweek„p"fgn"72."97"{"322'"
gp"gn"p¿ogtq"fg"CP"htgpvg"c"nc"ukvwcek„p"dcucn."tgurgevk-
xcogpvg+0
Guvg"rctƒogvtq"gu"gurgekcnogpvg"¿vkn"gp"nc"ogfkek„p"fg"nc"
tgurwguvc"cn"vtcvcokgpvq"ofifkeq"*vkgpg"gp"ewgpvc"ngukqpgu"
kpàcocvqtkcu"{"pq"kpenw{g"ngukqpgu"guvƒvkecu."eqoq"ekecvtk-
egu+0
Monitori¦aci„n ecogrƒÞca
Nc"oqpkvqtk¦cek„p"fg"nc"tgurwguvc"vgtcrfiwvkec"fgn"rcekgpvg"
eqp"JU"gu"gp"qecukqpgu"fkh ekn"fg"tgcnk¦ct"fgufg"gn"rwpvq"fg"
xkuvc"en pkeq."fcfq"swg"owejcu"fg"ncu"ngukqpgu"ug"gpewgpvtcp"
gp"rncpqu"rtqhwpfqu"{"uqp"kpfgvgevcdngu"gp"nc"gzrnqtcek„p"
h ukec"dƒukec0
Nc"geqitch c"ug"eqpxkgtvg"gp"wpc"jgttcokgpvc"swg"rgtokvg"
oglqtct"nc"oqpkvqtk¦cek„p"fgn"rcekgpvg"eqp"JU0
Rrotocolo de monitori¦ación ecográÞca. Nc"geqitch c"ew-
vƒpgc"gp"gn"rcekgpvg"eqp"JU"fgdg"tgcnk¦ctug"ukiwkgpfq"guvqu"
rcuqu<
30"
SuperÞcie de azilas e ingles0"Fcfc"nc"gngxcfc"htgewgpekc"
fg"chgevcek„p"uwden pkec32.3;.42
."ug"tgeqokgpfc"tgcnk¦ct"wpc"
gzrnqtcek„p"fg"guvcu"4"ƒtgcu"cpcv„okecu0
40"
Áreas con lesiones clínicamente evidentes0"Gp"guvqu"ecuqu."
nc"geqitch c"pqu"rgtokvktƒ"guvcdngegt"nc"gzvgpuk„p"{"gn"uwd-
vkrq"tgcn"fg"nc"nguk„p"qdugtxcfc"*Þi0":+0
50"
Áreas sintomáticas0"Cswgnncu"ƒtgcu"en pkecogpvg"pq"chge-
vcfcu"rgtq"eqp"u pvqocu"eqoq"fqnqt"q"rkeqt"gueqpfgp"gp"
owejcu"qecukqpgu"ngukqpgu"uwd{cegpvgu"swg"lwuvkÞecp"gn"
ewcftq0
Ukiwkgpfq"gn"guswgoc."gn"kphqtog"fg"ugiwkokgpvq"fgn"rc-
ekgpvg"eqp"JU"fgdgt c"kpenwkt"nqu"ukiwkgpvgu"rctƒogvtqu."tg-
ikuvtcfqu"rqt"ƒtgc"chgevcfc<
̋"P¿ogtq"fg"p„fwnqu"ugwfqsw uvkequ."eqngeekqpgu"n swkfcu"{"
h uvwncu0
̋"Nqecnk¦cek„p"cpcv„okec"fg"ncu"ngukqpgu<"ffitokec."jkrqffit-
okec."gve0
̋"Vcoc‚q"fg"ncu"ngukqpgu0"Ug"tgeqigtƒp"gn"glg"oc{qt."gn"og-
pqt"{"gn"vtcpuxgtuq0
̋"Cevkxkfcf"Fqrrngt"gp"gn"ƒtgc"c"guvwfkq0"Ug"vtcvc"fg"wp"
rctƒogvtq"fkpƒokeq"swg"tgàglc"wp"cwogpvq"fg"nc"xcuew-
nctk¦cek„p"fg"wp"ƒtgc"cpcv„okec."nq"ewcn"pqu"rgtokvg"oq-
pkvqtk¦ct"nc"cevkxkfcf"kpàcocvqtkc0"Cu ."nc"rtgugpekc"fg"
cevkxkfcf"Fqrrngt"gp"wp"ƒtgc"pqu"eqpÞtoc"gn"guvcfq"cevkxq"
fg"nc"gphgtogfcf"gp"fkejc"¦qpc"*Þiu0"6E"{"7E+0"Guvg"rctƒ-
ogvtq"tguwnvc"ow{"ugpukdng"c"nc"tgurwguvc"vgtcrfiwvkec."rqt"
nq"swg"oqfkÞecekqpgu"gp"nc"kpvgpukfcf"Fqrrngt"gp"gn"ugiwk-
okgpvq"pqu"rgtokvktƒ"fgvgtokpct"nqu"tguwnvcfqu"c"ncu"fkhg-
tgpvgu"vgtcrkcu"ofifkecu"kpuvcwtcfcu0
Cambios ecográÞcos en la monitori¦ación de la jidradeni-
tis supurativa. Nc"geqitch c"ewvƒpgc"owguvtc"wpc"ugtkg"fg"
ecodkqu"geqitƒÞequ"swg"pqu"rwgfgp"c{wfct"c"fgvgevct"rtg-
eq¦ogpvg"nc"tgurwguvc"vgtcrfiwvkec0
Figura 8 C+"Nguk„p"en pkecogpvg"uwiguvkxc"fg"cdueguq0"D+"Nc"
geqitch c"tgxgnc"swg"nc"nguk„p"tgcnogpvg"ug"eqttgurqpfg"eqp"
wpc"h uvwnc0
Área clínicamente afecta
Área ecográica afecta

9. Geqitch c"fg"nc"jkftcfgpkvku"uwrwtcvkxc" 79
kpàcocek„p."ug"rncpvgc"nc"kpvgtxgpek„p"swkt¿tikec."nc"fgek-
uk„p"fg"fgnkokvct"gn"ƒtgc"c"gzvktrct"uwrqpg"qvtq"tgvq"vgtcrfiw-
vkeq0
En pkecogpvg."nc"ukvwcek„p"jcdkvwcn"gu"nc"fg"wpc"rkgn"fgu-
guvtwevwtcfc"eqp"ƒtgcu"fg"kpàcocek„p"{"fg"ekecvtkegu."swg"
jceg"eqornkecfq"fkuegtpkt"gpvtg"nc"rkgn"ucpc"{"nc"rcvqn„ikec0"
C"gnnq"ug"wpg"swg"ncu"h uvwncu"jcdkvwcnogpvg"pq"owguvtcp"gp"
Ecografía y cirugía en la hidradenitis
supurativa
Delimitaci„n de la extensi„n del ƒrea suir¿rgica
Gp"ncu"ukvwcekqpgu"swg."dkgp"rqt"htcecuq"fgn"vtcvcokgpvq"ofi-
fkeq"dkgp"rqt"d¿uswgfc"fg"qrvkok¦cek„p"fgn"eqpvtqn"fg"nc"
Figura 9 Gxqnwek„p"en pkec"fg"jkftcfgpkvku"uwrwtcvkxc"vtcu"kpkekq"fg"cfcnkowocd0"C+"Ugocpc"20"D+"Ugocpc"60"E+"Ugocpc"380"Ugiwk-
okgpvq"geqitƒÞeq"fg"nc"tgurwguvc"vgtcrfiwvkec0"C+"Eqngeek„p"n swkfc"Fqrrngt"-0"D+"Fguegpuq"fg"nc"cevkxkfcf"Fqrrngt0"E+"Tgfweek„p"
fgn"vcoc‚q"fg"nc"nguk„p"{"rtgugpekc"fg"ƒtgcu"jkrgtgeqifipkecu"fg"Þdtquku"ekecvtkekcn0"Pgicvkxk¦cek„p"fgn"Fqrrngt0
A B C
Figura 10 Gxqnwek„p"en pkec"fg"jkftcfgpkvku"uwrwtcvkxc"vtcu"kpkekq"fg"cfcnkowocd0"C+"Ugocpc"20"D+"Ugocpc"60"E+"Ugocpc"380"Ug-
iwkokgpvq"geqitƒÞeq"fg"nc"tgurwguvc"vgtcrfiwvkec0"C+"H uvwnc"Fqrrngt"-0"D+"Pgicvkxk¦cek„p"fgn"Fqrrngt0"E+"Tguqnwek„p"fg"nc"h uvwnc"
tgrtgugpvcfc"rqt"nc"gzkuvgpekc"fg"dcpfcu"jkrgtgeqifipkecu"egpvtcngu"fg"tgrctcek„p"fg"guvc0
A B C

10. 7:" C0"Octvqtgnn"{"L0O0"Ugiwtc"Rcncekqu
nc"xkuk„p"fktgevc"uw"vtc{gevq."swg"gp"owejcu"qecukqpgu"gu"
o¿nvkrng."rqt"nq"swg"ncu"kpvgtxgpekqpgu"uqp"uwd„rvkocu0
Nc"geqitch c"ewvƒpgc"gu"wpc"jgttcokgpvc"tƒrkfc"swg"rwgfg"
wvknk¦ctug"rtgqrgtcvqtkcogpvg"rctc"wpc"oglqt"fgnkokvcek„p"
fg"nc"kpvgtxgpek„p"gp"nc"JU0"Guvc"ug"dcuc"gp"nc"ecrcekfcf"fg"
nc"vfiepkec"fg"fgvgevct"fkhgtgpekcu"gpvtg"gn"vglkfq"ucpq"{"gn"
vglkfq"chgevcfq"rqt"nc"gphgtogfcf0
Seguimiento de la actividad inàamatoria en ƒreas
tratadas suir¿rgicamente
Nc"kpvgtxgpek„p"swkt¿tikec"cornkc."uqdtg"vqfq"gp"ecuqu"eqp"
JU"oqfgtcfc"{"itcxg"swg"cuqekcp"wp"eqorqpgpvg"kpàcocvq-
tkq"ukuvfiokeq."uwrqpg"gp"owejqu"ecuqu"nc"tgfweek„p"fg"nc"
cevkxkfcf"fg"nc"gphgtogfcf"rqt"fkuokpwek„p"fg"nc"ectic"kp-
àcocvqtkc0"Ukp"godctiq."nc"tgekfkxc"gu"tgncvkxcogpvg"htg-
ewgpvg"gp"nqu"ecuqu"fg"vtcvcokgpvq"swkt¿tikeq"ckuncfq0
Nc"gxcnwcek„p"en pkec."gp"guvqu"ecuqu."pqu"rgtokvg"uqurg-
ejct"nc"gzkuvgpekc"fg"tgekfkxc"rqt"nc"crctkek„p"fg"oqnguvkcu"
fg"vkrq"fqnqt"q"rkeqt"gp"gn"ƒtgc"vtcvcfc0"Ukp"godctiq."ukp"wpc"
rtwgdc"fg"kocigp"eqorngogpvctkc"tguwnvc"gp"owejcu"qec-
ukqpgu"korqukdng"fkhgtgpekct"gpvtg"wpc"tgekfkxc"q"nqu"u pvqocu"
rtqrkqu"fg"nc"ekecvtk¦"rquswkt¿tikec0
Nc"geqitch c"pqu"rgtokvg"fgvgevct"guvc"tgec fc"rtgeq¦."{"
eqp"gnnq"kpkekct"wp"vtcvcokgpvq"ofifkeq"q"swkt¿tikeq"ghgevkxq."
ogfkcpvg"nc"fgvgeek„p"fg"guvtwevwtcu"geqitƒÞecu"v rkecu"fg"
JU."swg"ug"gpvtgog¦encp"eqp"nqu"jcegu"fg"Þdtquku"ugewpfctkqu"
c"nc"ektwi c"*Þi0"34+."{"ogfkcpvg"nc"fgvgeek„p"fg"cevkxkfcf"
Fqrrngt."ukipq"kpfktgevq"fg"kpàcocek„p"cevkxc0
Conclusiones
Nc"gzrnqtcek„p"h ukec"fg"nc"JU"uwgng"ugt"rqeq"qdlgvkxc"{."jc-
dkvwcnogpvg."kphtcguvkoc"nc"itcxgfcf"{"nc"chgevcek„p"cpcv„-
okec"fg"ncu"ngukqpgu0
Nc"geqitch c"ewvƒpgc"rgtokvg"tgcnk¦ct"wpc"guvcfkÞecek„p"
tgcn."cu "eqoq"wpc"oqpkvqtk¦cek„p"fkpƒokec"fg"nc"cevkxkfcf"
kpàcocvqtkc"fg"nc"gphgtogfcf."oglqtcpfq"gn"ocpglq"fgn"
rcekgpvg"eqp"JU0
Conàicto de intereses
Nqu"cwvqtgu"fgenctcp"pq"vgpgt"pkpi¿p"eqpàkevq"fg"kpvgtgugu0
Bibliografía
30"Mwt¦gp"J."Mwtqmcyc"K."Lgoge"IDG."Govguvco"N."Ugnnjg{gt"M."
Ikcoctgnnqu/Dqwtdqwnku"GL."gv"cn0"Yjcv"ecwugu"jkftcfgpkvku"uwr-
rwtcvkxcA"Gzr"Fgtocvqn0"422:=39<677/940
40"Octvqtgnn"C0"Ewvcpgqwu"uqpqitcrj{"qh"kpàcoocvqt{"fkugcugu0"
Cevwcn"Ogfkec0"4236=;;"Uwrn"K<35/420
50"Lgoge"ID."Jgkfgpjgko"O."Pkgnugp"PJ0"Vjg"rtgxcngpeg"qh"jkftc-
fgpkvku"uwrrwtcvkxc"cpf"kvu"rqvgpvkcn"rtgewtuqt"ngukqpu0"L"Co"
Cecf"Fgtocvqn0"3;;8=57<3;3/60
60"Tgxw¦"LG."Ecpqwk/Rqkvtkpg"H."Yqnmgpuvgkp"R."Xkcnngvvg"E."Icdkuqp"
I."Rqwigv"H."gv"cn0"Rtgxcngpeg"cpf"hcevqtu"cuuqekcvgf"ykvj"jkftc-
fgpkvku"uwrrwtcvkxc<"Tguwnvu"htqo"vyq"ecug/eqpvtqn"uvwfkgu0"L"
Co"Cecf"Fgtocvqn0"422:=7;<7;8/8230
70"Ecpqwk/Rqkvtkpg"H."Tgxw¦"LG."Yqnmgpuvgkp"R."Xkcnngvvg"E."Icdkuqp"
I."Rqwigv"H."gv"cn0"Enkpkecn"ejctcevgtkuvkeu"qh"c"ugtkgu"qh"524"
Figura 11 KpÞnvtcek„p"geqiwkcfc"fg"eqtvkeqkfg"kpvtcngukqpcn0"
Qdufitxgug"nc"kocigp"jkrgtgeqkec"eqttgurqpfkgpvg"eqp"gn"eqtvk-
eqkfg"n swkfq"gpvtcpfq"gp"gn"kpvgtkqt"fgn"p„fwnq"ugwfqsw uvkeq0
Acetónido de triamcinolona entrando en la lesión (flecha)
Figura 12 Rcekgpvg"eqp"jkftcfgpkvku"uwrwtcvkxc"itcfq"KKK"kpvgt-
xgpkfq"jceg"5"ogugu"ogfkcpvg"gzfitguku"cornkc"gp"codcu"tgikq-
pgu"kpiwkpcngu."swg"cewfg"rqt"fqnqt"gp"kping"k¦swkgtfc0"Nc"geq-
itch c"eqpÞtoc"nc"cevkxkfcf"kpàcocvqtkc"tgrtgugpvcfc"rqt"nc"
gzkuvgpekc"fg"h uvwncu"kpvgteqowpkecfcu"gpvtg"vcdkswgu"ekecvtk-
ekcngu0
Líneas hiperecogénicas
(cicatrices)
Áreas iso e hipoecogénicas
(colecciones líquidas y fístula)

11. Geqitch c"fg"nc"jkftcfgpkvku"uwrwtcvkxc" 7;
370"Yqtvuocp"Z."Lgoge"IDG0"Tgcn/vkog"eqorqwpf"kocikpi"wnvtcuqwpf"
qh"jkftcfgpkvku"uwrrwtcvkxc0"Fgtocvqnqike"Uwti0"4229=55<3562/40
380"Yqtvuocp"Z."Lgoge"IDG0"Kocikpi"jkftcfgpkvku"uwrrwtcvkxc."
ejcrvgt"70"Gp<"Lgoge"IDG."Tgxw¦"L."Ng{fgp"LL."gfkvqtu0"Jkftc-
fgpkvku"uwrrwtcvkxc0"3uv"gf0"Jgkfgndgti."Igtocp{."Rc<"Urtkpigt="
42280"r0"56/90
390"Yqtvuocp"Z."Ecttg‚q"N."Oqtcngu"E0"Kpàcoocvqt{"fkugcugu"qh"
vjg"umkp0"Gp<"Yqtvuocp"Z."Lgoge"ID."gfkvqtu0"Fgtocvqnqike"wn-
vtcuqwpf"ykvj"enkpkecn"cpf"jkuvqnqike"eqttgncvkqpu0"Pgy"[qtm<"
Urtkpigt="42350"r0"95/3390
3:0"Yqtvuocp"Z."Lgoge"IDG0"C"5F"wnvtcuqwpf"uvwf{"qh"ukpwu"vtcev"
hqtocvkqp"kp"jkftcfgpkvku"uwrrwtcvkxc0"Fgtocvqn"Qpnkpg"L0"
4235=3;<3/3;0
3;0"Octvqtgnn"C."Ucp¦/Oqvknxc"X."Hgtpƒpfg¦/Etgjwgv"R."Jwguq"N."Rc-
ttc"O."Icte c/Ognictgu"O."gv"cn0"Wughwnpguu"qh"wnvtcuqpqitcrj{"
kp"oqpkvqtkpi"vjg"cevkxkv{"qh"jkftcfgpkvku<"gzrgtkgpeg"kp"c"urg-
ekcnk¦gf"wpkv0"Gwtqrgcp"Cecfgo{"qh"Fgtocvqnqi{"Urtkpi"U{orq-
ukwo0"42370"r0"U320
420"Ugiwtc/Rcncekqu"LO."Jgtpƒpfg¦/Kdƒ‚g¦"E."Oknnƒp/Ec{gvcpq"LH."
Fg"Vtq{c/Octv p"O0"Wvknkfcf"fg"nc"geqitch c"ewvƒpgc"gp"gn"fkci-
p„uvkeq."guvcfkÞecek„p"{"ocpglq"fg"nc"jkftqucfgpkvku"uwrwtcvk-
xc0"65"Eqpitguq"Pcekqpcn"fg"Fgtocvqnqi c"{"Xgpgtgqnqi c0"
42370"E925/40
430"Yqtuvocp."Z."Cnhcigog."H."Tqwuvcp"I."Ctkcu."U."Octvqtgnn."C."Ec-
vcncpq"Q."gv"cn0"Iwkfgnkpgu"hqt"rgthqtokpi"fgtocvqnqike"wnvtc-
uqwpf"d{"vjg"FGTOWU"itqwr0"L"Wnvtcuqwpf"Ogf0"42370"]Grwd"
cjgcf"qh"rtkpv̲0
440"Fcpd{"HY."Octiguuqp"NL0"Jkftcfgpkvku"uwrrwtcvkxc0"Fgtocvqn"
Enkp0"4232=4:<99;/;50
450"Uokvj"JU."Ejcq"LF."Vgkvgndcwo"L0"Rckphwn"jkftcfgpkvku"uwrrwtc-
vkxc0"Enkp"L"Rckp0"4232=48<657/660
460"Ocvwukcm"̅."Dkgpkgm"C."U¦grkgvqyumk"LE0"Ru{ejqrj{ukecn"curgevu"qh"
jkftcfgpkvku"uwrrwtcvkxc0"Cevc"Fgto"Xgpgtgqn0"4232=;2<486/:0
Htgpej"rcvkgpvu"ykvj"jkftcfgpkvku"uwrrwtcvkxc."ykvj"cp"cpcn{uku"
qh"hcevqtu"cuuqekcvgf"ykvj"fkugcug"ugxgtkv{0"L"Co"Cecf"Fgtoc-
vqn0"422;=83<73/90
80"Tgxw¦"L0"Jkftcfgpkvku"uwrrwtcvkxc0"L"Gwt"Cecf"Fgtocvqnqi{"Xg-
pgtgqn0"422;=45<;:7/;:0
90"Yqnmgpuvgkp"R."Nqwpfqw"C."Dcttcw"M."Cwswkgt"R."Tgxw¦"L0"Swcnkv{"
qh"nkhg"korcktogpv"kp"jkftcfgpkvku"uwrrwtcvkxc<"C"uvwf{"qh"83"ec-
ugu0"L"Co"Cecf"Fgtocvqn0"4229=78<843/50
:0"Guocpp"U."Lgoge"IDG0"Ru{ejquqekcn"korcev"qh"jkftcfgpkvku"uwr-
rwtcvkxc<"C"swcnkvcvkxg"uvwf{0"Cevc"Fgto"Xgpgtgqn0"4233=;3<
54:/540
;0"¥qwdqwnku"EE."Fguck"P."Govguvco"N."Jwpigt"TG."Kqcppkfgu"F."
Lwjƒu¦"K."gv"cn0"Gwtqrgcp"U3"iwkfgnkpg"hqt"vjg"vtgcvogpv"qh"jk-
ftcfgpkvku"uwrrwtcvkxc1cepg"kpxgtuc0"L"Gwt"Cecf"Fgtocvqnqi{"
Xgpgtgqn0"4237"=4;<83;/660
320"Yqtvuocp"Z."Oqtgpq"E."Uqvq"T."Ctgnncpq"L."Rg¦q"E."Yqtvuocp"L0"
Wnvtcuqwpf"kp/fgrvj"ejctcevgtk¦cvkqp"cpf"uvcikpi"qh"jkftcfgpk-
vku"uwrrwtcvkxc0"Fgtocvqnqike"Uwti0"4235=5;<3:57/640
330"Jwtng{"J0"Czknnct{"j{rgtjkftquku."crqetkpg"dtqojkftquku."jkftc-
fgpkvku"uwrrwtcvkxc."cpf"hcoknkcn"dgpkip"rgorjkiwu<"uwtikecn"
crrtqcej0"Gp<"Tqgpkij"TJ."gfkvqt0"Fgtocvqnqike"uwtigt{0"Pgy"
[qtm<"Octegn"Fgmmgt="3;:;0"r0"94;/5;0
340"Uctvqtkwu"M."Ncrkpu"L."Govguvco"N."Lgoge"ID0"Uwiiguvkqpu"hqt"
wpkhqto"qwveqog"xctkcdngu"yjgp"tgrqtvkpi"vtgcvogpv"ghhgevu"kp"
jkftcfgpkvku"uwrrwtcvkxc0"Dt"L"Fgtocvqn0"4225=36;<433/50
350"Uctvqtkwu"M."Govguvco"N."Lgoge"IDG."Ncrkpu"L0"Qdlgevkxg"ueq-
tkpi"qh"jkftcfgpkvku"uwrrwtcvkxc"tgàgevkpi"vjg"tqng"qh"vqdceeq"
uoqmkpi"cpf"qdgukv{0"Dt"L"Fgtocvqn0"422;=383<:53/;0
360"Mkodcnn"CD." Lgoge" ID."[cpi" O." Mcigngkt{"C." Ukipqtqxkvej"
LG."Qmwp"OO."gv"cn0"Cuuguukpi"vjg"xcnkfkv{."tgurqpukxgpguu"cpf"
ogcpkpihwnpguu"qh"vjg"jkftcfgpkvku"uwrrwtcvkxc"enkpkecn"tgurqp-
ug"*JkUET+"cu"vjg"enkpkecn"gpfrqkpv"hqt"jkftcfgpkvku"uwrrwtcvkxc"
vtgcvogpv0"Dt"L"Fgtocvqn0"4236=393<3656/640