The Value of High‐Frequency Ultrasound and Color Doppler Flow Imaging in Assessing the Efficacy of Moderate‐to‐Severe Acne Vulgaris: A Prospective Single‐Arm Study

OBJECTIVE: This study aimed to investigate the value of non-invasive skin detection techniques for the therapeutic assessment of moderate-to-severe acne vulgaris. METHODS: In this study, we collected patients with moderate-to-severe acne vulgaris who attended the Department of Dermatology at the First Affiliated Hospital of Guilin Medical University between October 2021 and December 2022, and analyzed their high-frequency ultrasound (HFUS) and color Doppler flow imaging (CDFI) characteristics at the Weekend 0 (T0), Weekend 4 (T1), and Weekend 12 (T2) of their treatment. RESULTS: A total of 30 patients with moderate-to-severe acne vulgaris [mean age 21.1 ± 3.4 years; 14 males (46.7%), 16 females (53.3%)] were enrolled. HFUS assessment revealed improvements (p < 0.05) in multiple parameters following treatment. Prior to treatment, there was perfect agreement (κ = 1.0) between the Pillsbury clinical grading and the SSSA ultrasound grading in all 30 patients (100%). Among the 30 patients who completed the 12-week follow-up, post-treatment ultrasound grading was higher than the clinical Pillsbury grading in 17 cases (56.7%). Agreement between the two grading methods post-treatment was poor (κ = 0.3, p = 0.645, 95% CI: -0.17, 0.77), though statistical significance was limited by sample size. CONCLUSION: HFUS effectively visualizes deep acne lesions (nodules/cysts). Although ultrasound grading demonstrates slower severity reduction than clinical assessment, it provides more objective severity evaluation. CDFI enhances hemodynamic analysis through real-time flow visualization. Combined HFUS/CDFI enables enhanced severity and prognostic assessment in moderate-to-severe acne vulgaris.