Ultraschall Med 2021; 42(01): 39-47
DOI: 10.1055/a-1161-8872
Guidelines & Recommendations

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound

Stellungnahme der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) zu Dermatologischem Ultraschall
Fernando Alfageme
1   Dermatology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
Ximena Wortsman
2   Department of Dermatology, Universidad de Chile, Santiago de Chile
Orlando Catalano
3   Radiology, Instituto Pascale, Naples, Italy
Gaston Roustan
1   Dermatology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
Maria Crisan
4   Dermatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
Diana Crisan
5   Dermatology, Universitätsklinikum Ulm Klinik für Dermatologie und Allergologie, Ulm, Germany
Diana E. Gaitini
6   Radiology, Rambam Medical Center, Haifa, Israel
Eugenio Cerezo
7   Ultrasound, Clinica DKV, Madrid, Spain
Radu Badea
8   Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy, “Iuliu Hatieganu”, Cluj-Napoca, Romania
› Author Affiliations


Dermatologic ultrasound is a recent application of ultrasound for the evaluation of healthy skin and appendages and their diseases. Although the scientific literature regarding this application is still not sufficient for evidence-based guidelines, general recommendations issued by scientific societies are necessary. The EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) steering committee for dermatologic ultrasound has developed a series of consensus position statements regarding the main fields of dermatologic ultrasound (technical requirement, normal skin and appendages, inflammatory skin diseases, tumoral skin diseases, aesthetic dermatology and practice-training requirements). This document is the foundation for future evidence-based recommendations and guidelines for dermatologic ultrasound practice.


Dermatologischer Ultraschall ist eine neuere sonografische Anwendung zur Beurteilung gesunder Haut, ihrer Adnexe und deren Erkrankungen. Obwohl die wissenschaftliche Literatur zu dieser Anwendung noch nicht für evidenzbasierte Leitlinien ausreicht, sind allgemeine Empfehlungen der wissenschaftlichen Gesellschaften erforderlich. Der Lenkungsausschuss für dermatologischen Ultraschall der EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) hat eine Reihe von Konsensus-Stellungnahmen zu den Hauptgebieten des dermatologischen Ultraschalls erarbeitet (technische Anforderungen, normale Haut und Adnexe, entzündliche Hauterkrankungen, Tumorerkrankungen der Haut, ästhetische Dermatologie und Anforderungen an die praktische Ausbildung). Dieses Dokument bildet die Grundlage für zukünftige evidenzbasierte Empfehlungen und Leitlinien für die Praxis des dermatologischen Ultraschalls.

Publication History

Received: 28 January 2020

Accepted: 09 April 2020

Article published online:
07 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Wortsman X. Common Applications of Dermatologic Sonography. Journal of Ultrasound in Medicine 2012; 31: 97-111
  • 2 Wortsman X, Alfageme F, Roustan G. et al. Guidelines for Performing Dermatologic Ultrasound Examinations by the DERMUS Group. J Ultrasound Med 2016; 35: 577-580
  • 3 Wortsman X, Alfageme F, Roustan G. et al. Proposal for an Assessment Training Program in Dermatologic Ultrasound by the DERMUS Group. J Ultrasound Med 2016; 35: 2305-2309
  • 4 Jenssen C, Gilja OH, Serra AL. et al. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Policy Document Development Strategy – Clinical Practice Guidelines, Position Statements and Technological Reviews. Ultrasound Int Open 2019; 5: E2-E10
  • 5 Kleinerman R, Whang TB, Bard RL. et al. Ultrasound in dermatology: principles and applications. J Am Acad Dermatol 2012; 67: 478-487
  • 6 Ulrich J, Schwürzer-Voit M, Jenderka K. et al. Sonographic diagnostics in dermatology. JDDG: Journal der Deutschen Dermatologischen Gesellschaft 2014; 12: 1083-1099
  • 7 Wortsman X, Carreño L, Ferreira-Wortsman C. et al Ultrasound Characteristics of the Hair Follicles and Tracts, Sebaceous Glands, Montgomery Glands, Apocrine Glands, and Arrector Pili Muscles. J Ultrasound Med 2019; 38: 1995-2004
  • 8 Wortsman X. et al. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. Journal of the American Academy of Dermatology 2010; 62: 247-256
  • 9 Echeverría-García B, Borbujo J, Alfageme F. The use of ultrasound imaging in dermatology. Actas Dermosifiliogr 2014; 105: 887-890
  • 10 Alfageme F. Broadening the Sonographic Spectrum of Vascular Anomalies. Actas Dermosifiliogr 2018; 109: 199
  • 11 Alfageme Roldán F, Mollet Sánchez J, Cerezo López E. Physical principles and general considerations. Actas Dermosifiliogr 2015; 106: 3-9
  • 12 Salgüero Fernández I, Alfageme Roldán F, Roustan Gullón G. Greater detection of small caliber blood vessels in port wine xtain with X mode than with conventional Doppler: A Pilot Study. Actas Dermosifiliogr 2017; 108: 690-692
  • 13 Alfageme F. Elastography in dermatology. Actas Dermosifiliogr 2016; 107: 652-660
  • 14 Crisan D, Crisan M, Badea R. et al. Integrative analysis of cutaneous skin tumours using ultrasonogaphic criteria. Preliminary results. Medical Ultrasonography 2014; 16: 285-290
  • 15 Welzel J, Schuh S. Noninvasive diagnosis in dermatology. Journal der Deutschen Dermatologischen Gesellschaft 2017; 15: 999-1016
  • 16 de Troya Martín M, Alfageme Roldán F. Ultrasound in dermatology: a new approximation to knowledge of the skin. Actas Dermosifiliogr 2015; 106: 1-2
  • 17 Wortsman X, Wortsman J, Matsuoka L. et al. Sonography in pathologies of scalp and hair. Br J Radiol 2012; 85: 647-655
  • 18 Wortsman X, Roustan G, Martorell A. Color Doppler ultrasound of the scalp and hair. Actas Dermosifiliogr 2015; 106: 67-75
  • 19 Wortsman X, Guerrero R, Wortsman J. Hair morphology in androgenetic alopecia: sonographic and electron microscopic studies. J Ultrasound Med 2014; 33: 1265-1272
  • 20 Wortsman X, Jemec GB. Ultrasound imaging of nails. Dermatol Clin 2006; 24: 323-328
  • 21 Vidal D, Echeverria B, García-Gavín J. et al. Ultrasound in the management of nail disease. Actas Dermosifiliogr 2015; 106: 60-66
  • 22 Crisan M, Crisan D, Sannino G. et al. Ultrasonographic staging of cutaneous malignant tumors: an ultrasonographic depth index. Arch Dermatol Res 2013; 305: 305-313
  • 23 Crisan D, Crisan M, Badea R. et al. Integrative analysis of cutaneous skin tumours using ultrasonogaphic criteria. Preliminary results. Medical Ultrasonography 2014; 16: 285-290
  • 24 Barcaui Ede O, Carvalho AC, Lopes FP. et al. High frequency ultrasound with color Doppler in dermatology. An Bras Dermatol 2016; 91: 262-273
  • 25 Increased Marginal Stiffness Differentiates Infiltrative From Noninfiltrative Cutaneous Basal Cell Carcinomas in the Facial Area: A Prospective Study. J Ultrasound Med 2019; 38: 1841-1845
  • 26 Dasgeb B, Morris MA, Mehregan D. et al. Quantified ultrasound elastography in the assessment of cutaneous carcinoma. Br J Radiol 2015; 88: 20150344
  • 27 MacFarlane D, Shah K, Wysong A. et al. The role of imaging in the management of patients with nonmelanoma skin cancer: Diagnostic modalities and applications. J Am Acad Dermatol 2017; 76: 579-588
  • 28 Wortsman X. Sonography of facial cutaneous basal cell carcinoma: a first-line imaging technique. J Ultrasound Med 2013; 32: 567-572
  • 29 Vega N, Wortsman X, Navarrete N. et al. Color Doppler Ultrasound Supports Early Diagnosis of Mixed High and Low Risk of Recurrence Subtypes in the Same Basal Cell Carcinoma Lesion. Dermatol Surg 2018; 44: 741-743
  • 30 Wortsman X, Vergara P, Castro A. et al. Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin. J Eur Acad Dermatol Venereol 2015; 29: 702-707
  • 31 Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol 2018; 78: 237-247
  • 32 Catalano O, Setola SV, Vallone P. et al. Sonography for locoregional staging and follow-up of cutaneous melanoma: how we do it. J Ultrasound Med 2010; 29: 791-802
  • 33 Catalano O, Caracò C, Mozzillo N. et al. Locoregional spread of cutaneous melanoma: sonography findings. Am J Roentgenol 2010; 194: 735-745
  • 34 Catalano O, Siani A. Cutaneous melanoma: role of ultrasound in the assessment of locoregional spread. Curr Probl Diagn Radiol 2010; 39: 30-36
  • 35 Carrascosa R, Alfageme F, Roustán G. et al. Skin ultrasound in Kaposi sarcoma. Actas Dermosifiliogr 2016; 107: e19-22
  • 36 Catalano O, Alfageme Roldán F, Scotto di Santolo M. et al. Color Doppler Sonography of Merkel Cell Carcinoma. J Ultrasound Med 2018; 37: 285-292
  • 37 Mandava A, Koppula V, Wortsman X. et al The clinical value of imaging in primary cutaneous lymphomas: Role of high resolution ultrasound and PET-CT. Br J Radiol 2019; 92: 20180904
  • 38 Tomich J, Grove Nigro K, Barr RG. Primary Angiosarcoma of the Breast: A Case Report and Review of the Literature. Ultrasound Q 2017; 33: 46-48
  • 39 Wortsman X, Jemec G. Common inflammatory diseases of the skin: From the skin to the screen. Adv Psoriasis Inflammatory Skin Dis 2010; 2: 9-15
  • 40 Wortsman X, Wortsman J, Sazunic I. et al. Activity assesment in morphea using color doppler ultrasound. J Am Acad Dermatol 2011; 65: 942-948
  • 41 Alfageme Roldan F. Ultrasound skin imaging. Actas Dermosifiliogr 2014; 105: 891-899
  • 42 Wortsman X, Jemec GB, Sazunic I. Anatomical detection of inflammatory changes associated with plantar warts by ultrasound. Dermatology 2010; 220: 213-217
  • 43 Ramirez-Schrempp D, Dorfman DH, Baker WE. et al. Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain?. Pediatr Emerg Care 2009; 25: 44-48
  • 44 Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005; 12: 601-606
  • 45 Gutierrez M, Wortsman X, Filippucci E. et al. High-frequency sonography in the evaluation of psoriasis: nail and skin involvement. J Ultrasound Med 2009; 28: 1569-1574
  • 46 Gutierrez M, Filippucci E, Bertolazzi C. et al. Sonographic monitoring of psoriatic plaque. J Rheumatol 2009; 36: 850-851
  • 47 De Agustín JJ, Moragues C, De Miguel E. et al. A multicentre study on high-frequency ultrasound evaluation of the skin and joints in patients with psoriatic arthritis treated with infliximab. Clin Exp Rheumatol 2012; 30: 879-885
  • 48 Gutierrez M, Wortsman X, Filippucci E. et al. High-frequency sonography in the evaluation of psoriasis: nail and skin involvement. J Ultrasound Med 2009; 28: 1569-1574
  • 49 Moreno M, Lisbona MP, Gallardo F. et al. Ultrasound Assessment of Psoriatic Onychopathy: A Cross-sectional Study Comparing Psoriatic Onychopathy with Onychomycosis. Acta Derm Venereol 2019; 99: 164-169
  • 50 Krajewska-Włodarczyk M, Owczarczyk-Saczonek A, Placek W. et al. Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis. Sci Rep 2019 Mar 2019; 9: 3628
  • 51 Vidal D, Alfageme F, Ruiz-Villaverde R. et al. Ultrasound Characterization of Psoriasis of the Nails: A Case-Control Study. Actas Dermosifiliogr 2017; 108: 968-996
  • 52 Naredo E, Janta I, Baniandrés-Rodríguez O. et al. To what extend is nail ultrasound discriminative between psoriasis, psoriatic arthritis and healthy subjects?. Rheumatol Int 2019; 39: 697-705
  • 53 Wortsman X, Jemec GBE. High frequency ultrasound for the assessment of hidradenitis suppurativa. Dermatol Surg 2007; 33: 1-3
  • 54 Wortsman X, Moreno C, Soto R. et al. Ultrasound in-depth characterization and staging of hidradenitis suppurativa. Dermatol Surg 2013; 39: 1835-1842
  • 55 Martorell A, Alfageme Roldán F, Vilarrasa Rull E. et al Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study. J Eur Acad Dermatol Venereol 2019; 33: 2137-2142 . doi:10.1111/jdv.15710 [Epub ahead of print]
  • 56 Wortsman X, Wortsman J, Sazunic I. et al. Activity assessment in morphea using color Doppler ultrasound. J Am Acad Dermatol 2011; 65: 942-948
  • 57 Li SC, Liebling MS, Haines KA. et al. Initial evaluation of an ultrasound measure for assessing the activity of skin lesions in juvenile localized scleroderma. Arthritis Care Res 2011; 63: 735-742
  • 58 Suliman YA, Kafaja S, Fitzgerald J. et al. Ultrasound characterization of cutaneous ulcers in systemic sclerosis. Clin Rheumatol 2018; 37: 1555-1561
  • 59 Lorente M, Alfageme F, González C. Ultrasound Diagnosis of Calcified Skin Deposits. Actas Dermosifiliogr 2015; 106: 586-588
  • 60 Wang Y, Shan JL, Chen HY. et al. Comparison of 2-D shear wave elastography with clinical score in localized scleroderma: A new method to increase the diagnostic accuracy. Dermatol 2019; 46: 131-138
  • 61 Wortsman X. Sonography of cosmetic procedures. In: Wortsman X, Jemec GBE. eds. Dermatologic Ultrasound with Clinical and Histologic Correlations. 1st ed. New York, NY: Springer NY; 2013: 373-399
  • 62 Wortsman X. Common Applications of Ultrasound in Cosmetics and Plastic Surgery. In: Wortsman X. ed. Atlas of Dermatologic Ultrasound. 1st ed. New York: Springer; 2018: 179-214
  • 63 Schelke LW, Van Den Elzen HJ, Erkamp PPM. et al. Use of ultrasound to provide overall information on facial fillers and surrounding tissue. Dermatologic Surg 2010; 36: 1843-1851
  • 64 Gniadecka M, Gniadecki R, Serup J. et al. Ultrasound structure and digital image analysis of the subepidermal low echogenic band in aged human skin: Diurnal changes and interindividual variability. J Invest Dermatol 1994; 102: 362-365
  • 65 Wortsman X, Wortsman J. Sonographic outcomes of cosmetic procedures. Am J Roentgenol 2011; 197: W910-W918
  • 66 Kwon HJ, Kim BJ, Ko EJCS. The Utility of Color Doppler Ultrasound to Explore Vascular Complications After Filler Injection. Dermatol Surg 2017; 43: 1508-1510
  • 67 Wortsman X. Identification and complications of cosmetic fillers: Sonography first. J Ultrasound Med 2015; 34: 1163-1172
  • 68 U.S. Food and Drug Administration. Dermal Fillers. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/CosmeticDevices/ucm619837.htm Published 2018. Accessed 2018 September 14
  • 69 Villegas Fernández C, Burón CÁlvarez I, Fernández-Tresguerres Centeno A. et al. Ecografía cutánea y rellenos dermatológicos. Actas Dermosifiliogr 2015; 106: 87-95
  • 70 Grippaudo FR, Mattei M. High-frequency sonography of temporary and permanent dermal fillers. Ski Res Technol 2010; 6: 265-269
  • 71 Pérez-Pérez L, García-Gavín J, Wortsman X. et al. Delayed adverse subcutaneous reaction to a new family of hyaluronic acid dermal fillers with clinical, ultrasound, and histologic correlation. Dermatologic Surg 2017; 43: 605-608
  • 72 Cassuto D, Pignatti M, Pacchioni L. et al. Management of complications caused by permanent fillers in the face: A treatment algorithm. Plast Reconstr Surg 2016; 138: 215e-227e
  • 73 Quezada-Gaón N, Wortsman X. Ultrasound-guided hyaluronidase injection in cosmetic complications. J Eur Acad Dermatology Venereol 2016; 30: e39-e40
  • 74 Quezada-Gaon N, Wortsman X, Peñaloza O. et al. Comparison of clinical marking and ultrasound-guided injection of Botulinum type A toxin into the masseter muscles for treating bruxism and its cosmetic effects. J Cosmet Dermatol 2016; 5: 238-244
  • 75 Martorell A, Wortsman X, Alfageme F. et al. Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa: Proposal of a Standarized Report. Dermatol Surg 2017; 43: 1065-1107
  • 76 Alfageme F, Cerezo E, Fernandez IS. et al. Introduction of basic dermatologic ultrasound in undergraduate medical education. Ultrasound Int Open 2016; 2: E136-E139
  • 77 Spanish Society of Ultrasound. Accreditation in Dermatology and aesthetic medicine. http://www.seeco.es/index.php/en/sociedad-espanola-de-ecografia-2/acreditacion-2 Accessed 2019 August 30th