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Review
. 2025 Jan 26;61(2):220.
doi: 10.3390/medicina61020220.

High-Frequency and Ultra-High-Frequency Ultrasound in Dermatologic Diseases and Aesthetic Medicine

Giulio Argalia  1 , Alfonso Reginelli  2 , Elisa Molinelli  3 , Anna Russo  2 , Alessandra Michelucci  4   5 , Andrea Sechi  6 , Angelo Valerio Marzano  6   7 , Stella Desyatnikova  8 , Marco Fogante  1 , Vittorio Patanè  2 , Giammarco Granieri  4 , Corrado Tagliati  9 , Giulio Rizzetto  3 , Edoardo De Simoni  3 , Marco Matteucci  3 , Matteo Candelora  3 , Cecilia Lanza  1 , Claudio Ventura  1 , Nicola Carboni  1 , Roberto Esposito  10 , Stefano Esposito  11 , Massimiliano Paolinelli  12 , Elisabetta Esposto  13 , Giuseppe Lanni  14 , Gabriella Lucidi Pressanti  14 , Chiara Giorgi  15 , Fabiola Principi  16 , Alberto Rebonato  17 , Sylwia Patrycja Malinowska  18 , Robert Krzysztof Mlosek  19 , Gian Marco Giuseppetti  20 , Valentina Dini  4 , Marco Romanelli  4 , Annamaria Offidani  3 , Salvatore Cappabianca  2 , Ximena Wortsman  21   22   23   24 , Oriana Simonetti  3
Affiliations
Review

High-Frequency and Ultra-High-Frequency Ultrasound in Dermatologic Diseases and Aesthetic Medicine

Giulio Argalia et al. Medicina (Kaunas). .

Abstract

Dermatologic ultrasonography applications are rapidly growing in all skin fields. Thanks to very high spatial resolution, high-frequency and ultra-high-frequency ultrasound can evaluate smaller structures, allowing us to improve diagnosis accuracy and disease activity. Moreover, they can guide treatment, such as drug injection, and assess therapy efficacy and complications. In this narrative review, we evaluated high-frequency ultrasound and ultra-high-frequency ultrasound in infections, inflammatory dermatoses, metabolic and genetic disorders, specific cutaneous structure skin disorders, vascular and external-agent-associated disorders, neoplastic diseases, and aesthetics.

Keywords: dermatology; high-frequency ultrasound; ultra-high-frequency ultrasound.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Normal non-glabrous skin at 70 MHz with a superficial bright hyperechoic monolaminar layer, which is the epidermis, a thicker but less hyperechoic band that corresponds to the dermis, and a deeper hypoechoic structure that represents the subcutaneous tissue. Notice the hyperechoic oval-shaped structure of the sebaceous gland and a hypoechoic oblique band that corresponds to the hair follicle.
Figure 2
Figure 2
Third toe abscess in a color Doppler 70 MHz image: small inhomogeneous hypoechoic structure with peripheral hypervascularization.
Figure 3
Figure 3
Abscess in a color Doppler 20 MHz image: hypoechoic fluid-filled structure with evident peripheral vascular signals.
Figure 4
Figure 4
Grayscale 20 MHz ultrasound image of erysipelas shows a thickened, hyperechoic dermis with a hypoechoic band of fluid and hyperechoic surrounding subcutaneous edema, without abscess formation.
Figure 5
Figure 5
Grayscale 20 MHz ultrasound image of cutaneous leishmaniasis showing well-defined, homogenous hypoechoic dermal structure (between markers), with minimal reactive changes in the underlying hypodermis (pauci-inflammatory pattern).
Figure 6
Figure 6
Power Doppler 20 MHz ultrasound image of an ulcerated plaque of cutaneous leishmaniasis shows a diffuse central vascular signal (inflammatory pattern).
Figure 7
Figure 7
B-mode 70 MHz ultrasound image of atopic dermatitis with evident decreased echogenicity of the upper dermis.
Figure 8
Figure 8
Atopic dermatitis with evident hypoechoic upper dermal band at 48 MHz.
Figure 9
Figure 9
B-mode 70 MHz ultrasound image of a pyoderma gangrenosum lesion.
Figure 10
Figure 10
Subepidermal blister in bullous pemphigoid at 70 MHz.
Figure 11
Figure 11
Intraepidermal blister in pemphigus vulgaris at 70 MHz.
Figure 12
Figure 12
Panniculitis with hyperechoic lobules and hypoechoic septa in a thickened hypodermis using a 20 MHz probe.
Figure 13
Figure 13
Right elbow subcutaneous calcifications in a patient with systemic sclerosis using a 24 MHz probe.
Figure 14
Figure 14
Grayscale 20 MHz ultrasound of pseudoxanthoma elasticum on the neck. The involved area is delimited by yellow stars and shows a mild decrease in dermal echogenicity in a small single papular lesion.
Figure 15
Figure 15
An oval dermal and subcutaneous heterogeneous hypoechogenic trichilemmal cyst in the scalp with keratinized material and hair fragment inside at 24 MHz.
Figure 16
Figure 16
Acne pseudocyst at 70 MHz: oval-shaped hypoechoic structure within the hypodermis.
Figure 17
Figure 17
Forehead acne scar at 48 MHz with evident epidermal depression.
Figure 18
Figure 18
Hidradenitis suppurativa microtunnel at 70 MHz.
Figure 19
Figure 19
Hidradenitis suppurativa microcyst or ballooned hair follicle with 70 MHz probe.
Figure 20
Figure 20
Hidradenitis suppurativa fluid collection at 70 MHz.
Figure 21
Figure 21
Grayscale 20 MHz ultrasound image showing a subcutaneous fluid collection in the buttock of a patient with hidradenitis suppurativa. A retained hair fragment is visible as a linear hyperechoic structure within the abscess and aligned parallel to the skin surface.
Figure 22
Figure 22
Hidradenitis suppurativa pseudocyst at 48 MHz.
Figure 23
Figure 23
A 24 MHz ultrasound image showing a pilonidal sinus with hair fragments.
Figure 24
Figure 24
A 70 MHz ultrasound image shows a thickened, hyperechoic, and wavy nail plate with an increased thickness of the nail bed in a patient with psoriasis.
Figure 25
Figure 25
Longitudinal grayscale 20 MHz ultrasound of onychomadesis: note the abrupt interruption of the nail plate (arrow).
Figure 26
Figure 26
Glomus tumor of the right thumb at 24 MHz. Oval-shaped, well-defined, hypoechoic nodule that corresponds to a glomus tumor. There is hypervascularity within the tumor. Notice the scalloping of bony margin (arrow).
Figure 27
Figure 27
Longitudinal 20 MHz grayscale ultrasound of a digital myxoid cyst, showing a well-circumscribed anechoic lesion, with nail plate splitting due to compression on the matrix region and distal interphalangeal joint osteophytes.
Figure 28
Figure 28
Left cheek vascular malformation with 24 MHz probe: hyperechoic subcutaneous tissue with evident vascular signals on color Doppler.
Figure 29
Figure 29
A 70 MHz ultrasound image shows a venous ulcer with a decreased echogenicity band in the perilesional tissue.
Figure 30
Figure 30
Active keloid. Hypoechoic laminar dermal thickening at 24 MHz that corresponds to a keloid (*). Notice the hypervascularity within the lesion.
Figure 31
Figure 31
Garden cane fragment in the subcutis above the superficial head of first dorsal interosseous muscle of the right hand with a 24 MHz probe.
Figure 32
Figure 32
Glass fragment in the subcutis above the distal interphalangeal joint of the third finger with 24 MHz probe.
Figure 33
Figure 33
Power Doppler 20 MHz ultrasound image of an ulcerated nodular basal cell carcinoma of the preauricular area detects a well-defined, hypoechoic, round-shaped lesion with homogeneous echotexture, peripheral vascularity, and calcification with acoustic shadowing.
Figure 34
Figure 34
A 70 MHz ultra-high-frequency ultrasound image of a hypoechoic subepidermal and dermal basal cell carcinoma (*). Notice the hyperechoic spots within the tumor (arrows).
Figure 35
Figure 35
Hypoechoic subepidermal, dermal, and dermo-hypodermal junction cheek superficial basal cell carcinoma at 48 MHz.
Figure 36
Figure 36
Power Doppler 20 MHz ultrasound image of an invasive G3 cutaneous squamous cell carcinoma reveals a hypoechoic, oval-shaped dermal mass with irregular borders, heterogeneous echotexture, and increased vascularity.
Figure 37
Figure 37
Color Doppler 48 MHz ultra-high-frequency ultrasound image of a hypoechoic in situ squamous cell carcinoma with mild mainly peripheral vascularization.
Figure 38
Figure 38
Two pseudonodular hypoechoic nose primary cutaneous B-cell lymphoma lesions at 48 MHz.
Figure 39
Figure 39
Grayscale 20 MHz ultrasound of a pilomatrixoma, showing a well-defined, round-shaped, mildly hypoechoic hypodermic mass with characteristic calcium spots and partial hypoechoic rim.
Figure 40
Figure 40
Subcutaneous dermatofibrosarcoma protuberans recurrent lesions with 24 MHz probe.
Figure 41
Figure 41
Dermo-epidermal hypoechoic round-shaped epidermal cyst with connecting tract toward the subepidermal and posterior enhancement at 24 MHz.
Figure 42
Figure 42
Mild hyperechoic oval-shaped lipoma of the left arm at 24 MHz.
Figure 43
Figure 43
Well-defined hypoechoic subgaleal lipoma with hyperechoic septa between the frontalis muscle and the deep fascia at 24 MHz.
Figure 44
Figure 44
Well-delimited fusiform perifascial hypoechoic encapsulated schwannoma with mild posterior enhancement at 24 MHz.
Figure 45
Figure 45
Irregular perifascial hypoechoic nodule with hyperechogenicity of the surrounding tissue because of edema, attached to the fascial layer in the deepest border representing nodular fasciitis at 24 MHz.
Figure 46
Figure 46
Cellulite at 50 MHz with evident papillae adiposae.
Figure 47
Figure 47
Temple hyaluronic acid filler injection at the interfascial plane (20 MHz).
Figure 48
Figure 48
Suborbicularis oculi fat extensive deposits of hyaluronic acid, sagittal view at 20 MHz.
Figure 49
Figure 49
Prejowl sulcus polymethylmethacrylate at 20 MHz.
Figure 50
Figure 50
Nose silicone implant, sagittal view at 20 MHz.
Figure 51
Figure 51
Color Doppler image of infraorbital inflammatory hyaluronic acid nodule at 20 MHz.
Figure 52
Figure 52
Color Doppler image of multiple glabella arteries and veins at 20 MHz.
Figure 53
Figure 53
Color Doppler image of nasal radix intercanthal vein at 20 MHz.
Figure 54
Figure 54
Color Doppler image of nasal tip cartilage and multiple arteries at 20 MHz.
Figure 55
Figure 55
Color Doppler image of the deep temporal artery at 20 MHz.
Figure 56
Figure 56
Color Doppler image of the zygomaticotemporal artery at 24 MHz.
Figure 57
Figure 57
Facial artery near-occlusion at the mandible at 20 MHz.
Figure 58
Figure 58
Angular artery with adjacent hyaluronic acid deposits: ultrasound-guided hyaluronidase injection in a case of vascular occlusion at 20 MHz.
Figure 59
Figure 59
Ultrasound-guided hyaluronidase injection to an inflammatory infraorbital hyaluronic acid nodule.
Figure 60
Figure 60
Hyaluronidase injection to an inflammatory prejowl hyaluronic acid nodule next to facial artery at 20 MHz.
Figure 61
Figure 61
Hyaluronidase injection to retroseptal hyaluronic acid deposit at 20 MHz.
See this image and copyright information in PMC

References

    1. Gaurav V., Agrawal S., Najeeb A., Ahuja R., Saurabh S., Gupta S. Advancements in Dermatological Imaging Modalities. Indian Dermatol. Online J. 2024;15:278–292. doi: 10.4103/idoj.idoj_852_23. - DOI - PMC - PubMed
    1. Alma A., Sticchi A., Chello C., Guida S., Farnetani F., Chester J., Bettoli V., Pellacani G., Manfredini M. Dermoscopy, Reflectance Confocal Microscopy and Optical Coherence Tomography Features of Acne: A Systematic Review. J. Clin. Med. 2022;11:1783. doi: 10.3390/jcm11071783. - DOI - PMC - PubMed
    1. Crisan D., Wortsman X., Alfageme F., Catalano O., Badea A., Scharffetter-Kochanek K., Sindrilaru A., Crisan M. Ultraso-nography in dermatologic surgery: Revealing the unseen for improved surgical planning. J. Dtsch. Dermatol. Ges. 2022;20:913–926. - PubMed
    1. Rahmani E., Fayyazishishavan E., Afzalian A., Varshochi S., Amani-Beni R., Ahadiat S.A., Moshtaghi Z., Shafagh S.G., Khorram R., Asadollahzade E., et al. Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis. Arch. Acad. Emerg. Med. 2023;11:e49. - PMC - PubMed
    1. Barbic D., Chenkin J., Cho D.D., Jelic T., Scheuermeyer F.X. In patients presenting to the emergency department with skin and soft tissue infections what is the diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess compared to the current standard of care? A systematic review and meta-analysis. BMJ Open. 2017;7:e013688. - PMC - PubMed

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