Ultrasound-Guided Triamcinolone Injections for Hidradenitis Suppurativa Lesions: A Systematic Review and Meta-Analysis.

Objectives: To evaluate the role of ultrasound (US) guidance in intralesional triamcinolone (TAC) injections for hidradenitis suppurativa (HS) lesions and assess its impact on injection technique, clinical response rates, and patient-reported outcomes.

Methods: We conducted a systematic review of PubMed, Embase, and Cochrane databases from inception through October 2024. Studies that reported outcomes of US-guided TAC injections in patients with HS lesions (nodules, abscesses, or tunnels) were included. Data extraction included study design, lesion type, TAC concentration used, injection technique, clinical outcomes, and adverse events. Meta-analysis was performed to evaluate pooled clinical response rates, complete healing rates, and pain reduction. The protocol was registered on PROSPERO (CRD42024596593).

Results: Six studies encompassing 313 patients and 527 lesions were included. The pooled clinical response rate was 80.5% across all lesion types, with highest rates observed for abscesses (96.4%) and nodules (93.4%). Complete clinical healing was achieved in 69.8% of lesions. Meta-analysis of pain outcomes from 3 studies demonstrated a significant reduction in mean pain scores (standardized mean difference: -0.57; 95% CI: [-0.76, -0.37]; P = .0013). Adverse events were rare (5.4%) and no severe complications were reported.

Conclusions: US-guided TAC injections are a safe and potentially effective approach to treating HS lesions, particularly for complex or deep lesions. While preliminary data are promising, further randomized controlled studies are needed to directly compare outcomes with non-US-guided injections and to establish standardized protocols for injection technique.