Advanced Imaging in Dermatology
Dermatology is such a great specialty. We gain so much information just by looking at the skin. We recognize patterns—shapes, colors, and textures—that reflect underlying pathogenesis. We have learned what patterns correspond to an enormous array of conditions. Sometimes clinical history, laboratory findings, and biopsies are helpful, but it is remarkable how often all we need is to see something to know what it is.
I think this is best exemplified by what we still affectionately refer to as Kodachrome sessions, despite not having used Kodachrome fi lm or slides for a generation. Even early dermatology trainees can look at a projected image and give a differential based just on what is visible. Depending on the lighting, the projected image may not fully reflect the colors that would have been seen in the clinic, much less the textural changes in the skin, and sometimes the image is blurry. However, we can often look at the surface visual pattern and have a strong sense of what is going on. Looking closer may be unnecessary, as global patterns can be more informative than what we see up close. Then again, local magnification of a lesion with dermoscopy may show things that the naked eye cannot see.
Newer technologies may further enhance our ability to see informative structures and patterns. High-frequency ultrasound provides a low-cost, safe, and practical way to obtain deeper, finer structural details than what we can see with our eyes and our dermatoscopes. This issue features an article by Dr Jane Yoo on ultrasound. The opening of a window to deeper structures of the skin is intriguing. Dr Yoo’s description of the use of ultrasound to better assess hidradenitis suppurativa (HS) by seeing underlying pathology that our eyes alone cannot see from the surface is particularly exciting. Part of the difficulty in managing HS is that we often start treatment after irreversible changes in the dermis and subcutaneous tissue occur. Being able to catch and treat the disease at an earlier stage may be our best hope for better treatment options.
