An extended high‐frequency ultrasound protocol for assessing and quantifying of inflammation and fibrosis in localized scleroderma

Abstract

Background Clinical characteristics of the lesions are used to identify activity and damage in localized scleroderma (LoS). For high‐frequency ultrasound (HF‐US), the features of active lesions were described. Materials and Methods Clinical signs of activity and damage in LoS lesions were assessed with the use of Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and HF‐US by two examiners independently. All US images were obtained using a 20 MHz HF‐US (DermaLab System, Cortex Technology, Hadsund, Denmark). The dermal thickness (DT) and echogenicity (intensity score, IS) of the LoS lesional dermis were measured in the area of each lesion with the highest score for erythema (ER), skin thickness (ST), and dermal atrophy (DAT). Measurements were compared to the site‐matched unaffected skin. The relative difference of DT and IS values was calculated between each lesion and its normal control for comparison among different clinical scores for ER, ST, and DAT. Results A total of 92 lesions in 40 adult patients were examined with HF‐US. Thirty one lesions were erythematous, 26 were in sclerosis, and 35 were in atrophy. A correlation between the clinical evaluation of the LoS lesions and US measurements was found. The sensitivity and specificity of HF‐US were 97% and 90%, respectively. The positive predictive value was 83%, negative predictive value—98%. Interrater reliability was excellent for LoSCAT and HF‐US findings. Conclusion High‐frequency ultrasound allows an accurate assessment of the inflammatory and fibrotic skin lesions in LoS.

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

“…Most of the sclerotic and atrophic lesions had an increased echogenicity and the presence of hyperechogenicity was associated to the inflammatory phase, which was present in 96.8% of all the erythematous lesions. 51 Taken as a whole, the data from this study implies a correlation between the HUS findings and the clinical evaluation and reports a highfrequency HUS sensitivity of 97% and a 90% specificity. 51 Porta et al made a HUS (18 MHz linear probe) evaluation of 10 young LS patients, reporting a dermis thickness increase in LS lesions compared to healthy skin.…”

“…50 Ranosz-Janicka et al made a high-frequency HUS (20 MHz probe) evaluation of a total of 92 LS lesions in 40 adult patients and reported a dermal thickness increase in all erythematous and sclerotic lesions. 51 Conversely, there was a decrease in dermal thickness in 33/35 atrophic plaques. Most of the sclerotic and atrophic lesions had an increased echogenicity and the presence of hyperechogenicity was associated to the inflammatory phase, which was present in 96.8% of all the erythematous lesions.…”

“…Skin ultrasound allows a follow-up of LS lesions and has been proposed as a non-invasive, real-time imaging technique to assess and monitor the severity of localized scleroderma (LS) 35,37,[45][46][47][48][49][50][51][52][53] (Table 2). As far back as 30 years ago, it was recommended that B-mode skin ultrasound be used in clinical practice to evaluate LS patients.…”

High‐frequency ultrasonography of the scalp ‐ Comparison of ultrasound and trichoscopic images in healthy individuals

“…Trichoscopy comes to the evaluation of the surface of the skin 12 . On the other hand, HF‐USG which has been widely used in dermatology for over 20 years, 15 mainly in dermatooncology, but it has also found an application in monitoring diseases such as psoriasis vulgaris, atopic dermatitis, skin lymphomas, morphea, and skin condition assessment radiotherapy 16‐22 There are individual studies presenting the use of HF‐USG in hair imaging 5‐7 . It is recognized that transducers using frequencies around 15 MHz are not sensitive enough to visualize individual structures such as sebaceous glands, sweat glands, and the arrector pili muscles, which require higher frequencies, that is, 29‐71 MHz 5 …”

High-frequency ultrasound in clinical dermatology: a review

“…In the inflammatory phase there is a reduction in echogenicity of the skin and dermal thickening, whereas in the sclerotic phase there is increased echogenicity and thickening [63]. Finally, ultrasonographic features of sclerodermatous skin in the atrophic phase demonstrates thinning of the dermis with an echogenicity similar to unaffected surrounding skin [64].…”