Integrated Doppler and Elastography Assessment of Hidradenitis Suppurativa and Dactylitis

Multimodal high-resolution ultrasound, including B-mode, Power Doppler, MicroVessel Doppler, spectral Doppler, and strain elastography, was used to assess concomitant dactylitis and hidradenitis suppurativa (HS) in a 46-year-old woman with severe hidradenitis suppurativa (IHS4 = 28), who was diagnosed 1.5 years ago and has been using adalimumab. Axillary ultrasound demonstrated abscess cavities and draining fistulous tracts with marked structural distortion, increased vascular signal on advanced Doppler modalities, and heterogeneous stiffness patterns on elastography, consistent with active deep inflammatory involvement. Simultaneously, evaluation of the third right finger revealed flexor tendon sheath thickening, soft-tissue edema, Doppler-positive inflammatory activity, and altered biomechanical properties compatible with dactylitis. High-resolution ultrasound has been increasingly recognized as a valuable tool for evaluating inflammatory and structural changes in cutaneous diseases, including HS. These multimodal findings illustrate how structural, vascular, and biomechanical ultrasound parameters may provide complementary information for characterizing inflammatory tissue remodeling in HS associated with dactylitis. As this report describes a single patient, these elastographic observations should be considered exploratory and hypothesis-generating rather than evidence of clinical validation.