Marcio Bouer

Guidelines for Performing Dermatologic Ultrasound Examinations by the DERMUS Group.

To support standardization for performing dermatologic ultrasound examinations.

Localized scleroderma: assessment of the therapeutic response to phototherapy

BACKGROUND Scleroderma is a chronic autoimmune disease characterized by progressive connective tissue sclerosis and microcirculatory changes. Localized scleroderma is considered a limited disease. However, in some cases atrophic and deforming lesions may be observed that hinder the normal development. Literature reports indicate phototherapy as a therapeutic modality with favorable response in cutaneous forms of scleroderma. OBJECTIVES This study had the purpose of assessing the phototherapy treatment for localized scleroderma. METHODS Patients with localized scleroderma were selected for phototherapy treatment. They were classified according to the type of localized scleroderma and evolutive stage of the lesions. Clinical examination and skin ultrasound were used to demonstrate the results thus obtained. RESULTS Some clinical improvement was observed after an average of 10 phototherapeutic sessions. All skin lesions were softer at clinical palpation with scores reduction upon pre and post treatment comparison. The ultrasound showed that most of the assessed lesions presented a decrease in dermal thickness, and only five maintained their previous measure. Treatment response was similar regardless of the type of phototherapeutic treatment employed. CONCLUSIONS The proposed treatment was effective for all lesions, regardless of the phototherapeutic modality employed. The improvement was observed in all treated skin lesions and confirmed by clinical evaluation and skin ultrasound.

Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa: Proposal of a Standarized Report

BACKGROUND Staging and monitoring of patients with hidradenitis suppurativa (HS) have been traditionally based on clinical findings. However, the physical examination may show important limitations because of its poor sensitivity for differentiating between different lesion subtypes, and its low sensitivity to define the diseases activity. OBJECTIVE To develop a consensus ultrasound (US) report that could summarize the relevant anatomical characteristics and staging of patients considering the experience of radiologists and dermatologists working on imaging of HS. METHODS A questionnaire on different aspects related to US examination in HS was performed. A working group, called DERMUS, composed of doctors from 9 countries who have been working in dermatologic US applied in patients with HS on a regular basis were included to evaluate the different items provided. RESULTS A consensus US report to evaluate HS patients was established. CONCLUSION The authors present the first attempt to define a HS standardized sonographic report. This model would be the first effort to include this imaging technique as the first elective medical test for staging and monitoring patients, which can support therapeutic decisions by providing earlier, objective, deeper, anatomical, and comparative evaluations in this difficult to treat disease.

Common Benign Non-vascular Skin Tumors

In this chapter we will review the sonographic characteristics of common benign cutaneous tumors in correlation with clinical and histological features. Ultrasound can provide anatomical data on tumors of the skin that are unavailable at the time of the clinical examination. Therefore, knowledge of the sonographic morphology of these lesions can improve their clinical management.

Correlação clínica e ultra-sonográfica na esclerodermia localizada cutânea

OBJETIVO: Apresentar os aspectos ultra-sonograficos da esclerodermia localizada e relaciona-los com os aspectos clinicos. MATERIAIS E METODOS: Foram analisadas 23 lesoes de esclerodermia localizada em 21 pacientes. Foi utilizado equipamento Logiq 700 com transdutor linear de 6-14 MHz. Foram avaliados, pelo dermatologista, o estagio da doenca (inflamatorio ou atrofico), e pelo radiologista, a espessura e a ecogenicidade da derme nas regioes afetadas e sas adjacentes. Foi feito acompanhamento de sete casos apos tratamento. RESULTADOS: Todas as lesoes apresentaram perda do padrao ultra-sonografico normal da derme. Os casos de lesao clinicamente atrofica (52,2%; 12/23) corresponderam a reducao da espessura e aumento da ecogenicidade da derme e os casos de lesao clinicamente inflamatoria (47,8%; 11/23) corresponderam a aumento da espessura e reducao da ecogenicidade da derme. Controles pos-tratamento mostraram alteracoes na espessura da derme. CONCLUSAO: Os achados ultra-sonograficos nos permitem associar o aumento da espessura e a reducao da ecogenicidade da derme com a fase inflamatoria da doenca, e a reducao da espessura e o aumento da ecogenicidade da derme com a fase atrofica da doenca. Notamos tambem que e possivel quantificar a espessura da derme e usar essa informacao no controle pos-tratamento associada a avaliacao clinica.

Color Doppler Sonography of Extradigital Glomus Tumors.

We retrospectively collected cases of surgically proven extradigital glomus tumor (EDGT) and reviewed their demographic, clinical, and sonography features. A total of 18 single, subcutaneous EDGTs were gathered. All but one were located in the extremities. EDGTs typically appear as a small, hypoechoic, homogeneous, or slightly inhomogeneous, well‐delimited nodule, disposed horizontally and painful under probe pressure. Intranodular vascularization is always present. Feeding artery and efferent vein are typical but inconstant findings.

Ultrasound of Frequent Dermatologic Infections and Infestations

This chapter reviews the ultrasonographic appearance of common dermatologic infections and infestations and illustrates sonographic signs that may support the differential diagnosis of these entities. Though some of these conditions are more frequently seen in tropical countries or rural regions, they can be detected worldwide because of travel and immigration.

Ultrasonography as an objective tool for assessment of infantile hemangioma treatment with propranolol

Infantile hemangiomas (IHs) are the most common benign vascular tumors of childhood. Propranolol is an effective drug in treating IH. A reliable and complementary instrument is necessary to evaluate IH response to propranolol in addition to clinical and photographic assessments. Ultrasonography is a simple and non‐invasive technique that enables precise measurements of tumor size and contributes to objective follow‐up.

Contrast Enhanced Ultrasound in Squamous Cell Carcinoma

Contrast-enhanced ultrasound (CEU) has been successfully used in squamous cell carcinoma (SCC). It improves the detection of the vascularization in the primary tumor. Technical considerations, relevant concepts on SCC and CEU, and the advantages and disadvantages of using contrast in cutaneous squamous cell carcinoma are discussed in this chapter.