The Updated Role of Ultrasound in Assessing Dermatological Manifestations in Systemic Sclerosis

Abstract

Barbara Ruaro,1 Tania Santiago,2,3 Michael Hughes,4 Gemma Lepri,5 Gabriele Poillucci,6 Elisa Baratella,6 Francesco Salton,1 Marco Confalonieri1 1Unit of Pulmonology, University Hospital of Trieste, Trieste, Italy; 2Department of Rheumatology, Centro Hospitalare Universitário de Coimbra, Coimbra, Portugal; 3Medicine Faculty, University of Coimbra, Coimbra, Portugal; 4Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; 5Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, Florence, Italy; 6Department of Radiology, Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, ItalyCorrespondence: Barbara RuaroUnit of Pulmonology, University Hospital of Trieste, Trieste, ItalyTel [phone]Email [email protected]: Systemic sclerosis (SSc), an autoimmune connective tissue disease, characterized by skin fibrosis, increased dermal thickness and microvascular involvement. Fibroblasts and myofibroblasts deposit excessive amounts of collagenous and non-collagenous extracellular matrix components in the skin. This leads to microvascular abnormalities and Raynaud’s phenomenon, with painful digital ulcers (DU) at the fingertips adding to patient discomfort. The skin involvement and severity in SSc was evaluated by the Modified Rodnan skin score (mRSS). Although high-frequency ultrasound (HUS) has been widely researched in the study of skin thickness and DU in SSc, its adoption into clinical practice is not yet common. However, novel insights into the still relatively unknown disease pathogenesis in SSc and its evaluation may be provided by HUS, including early (pre-clinical) skin involvement. It may also be useful in both the evaluation and follow-up of DU. Indeed, it is a non-invasive, safe, inexpensive and reproducible method able to assess not only SSc patients’ cutaneous structural changes, but also their vascular system changes. Moreover, several recent studies have reported that elastosonography (ES) is of use when investigating skin involvement in systemic sclerosis. This review aims at providing information as to role HUS and ES play in research advancements and the clinical perspectives in the evaluation of skin thickness and DU in SSc patients.Keywords: systemic sclerosis, ultrasound, elastosonography, skin, skin thickness, digital ulcers

Keywords

• systemic sclerosis
• ultrasound
• elastosonography
• skin
• skin thickness
• digital ulcers