Ultrasound, since its first introduction in clinical dermatology in 1979, has continued to develop along with its popularity and utility. High-frequency ultrasound (HFUS), or ultrasound using a frequency of at least 10 megahertz (MHz), permits high-resolution imaging of the skin from the stratum corneum to the deep fascia. It is a non-invasive and easy-to-interpret tool that permits physicians to evaluate skin findings in real-time, facilitating increased diagnostic, management, and surgical capabilities. 

A few dermatologic lesions are identified due to their pathognomonic sonographic features. Like the “jellyfish” sign described in some cases of dermatofibrosarcoma protuberans, the “saw-tooth” pattern of cellulite. These Pathognomonic ultrasonographic features will continue to emerge with the integration of higher frequency ultrasound devices in clinical practice. For working with HFUS, a core international task force group formed by 15 physicians from 11 countries called the DERMUS (dermatologic ultrasound) group recommends dermatologists to use Doppler-capable ultrasound devices with a frequency of at least 15- to 22-MHz in all ultrasound examinations of the skin.

Ultrasound is recommended to be used in future dermatological practice, but there exist some limitations associated with the use of this tool like the skill of the operator being the major limitation. Accordingly, the DERMUS group suggests utilizing ultrasound a minimum of 300 times yearly to achieve minimum competency. Likewise, it is strongly advised that the dermatologist serves as the sonographer because of their long training in dermatologic pathologies and ability to correlate histology with clinical presentation of cutaneous lesions.

As the advancements in ultrasonography continue to grow, so will the broad applications of this imaging modality. 

Source- Levy J, Barrett DL, Harris N. et al. High-frequency ultrasound in clinical dermatology: a review. Ultrasound J, 2021,13(24). https://doi.org/10.1186/s13089-021-00222-w