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

Abstract

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.

Development of a Musculoskeletal Ultrasound Protocol to Evaluate Hand Pain in Systemic Sclerosis Patients

“…As the disease progresses, sclerodactyly becomes a leading cause of hand disability, increasing the risk for small joint contractures and digital ulcers. While the use of US to assess skin thickness is not widely adopted into clinical practice, there are numerous studies suggesting a positive correlation between US-measured skin thickness and histological skin thickness [30,31].…”

Updated Role of High-frequency Ultrasound in Assessing Dermatological Manifestations in Autoimmune Skin Diseases

“…Meanwhile, Zhang et al ( 14 ) found that the skin elasticity and the surface wave velocity of patients with SSc positively correlate with the modified Rodnan skin score, while there is no correlation between skin viscosity and the modified Rodnan skin score. The author of this article previously conducted an exploratory study of ultrasound manifestations in scleroderma (all lesions were compared with peripheral or contralateral normal skin) and summarized it as follows ( 23 , 24 ): in the oedematous phase, there were dermal thickening and a reduction in echogenicity of the skin, without apparent changes in the subcutaneous layer, probably because of inflammatory exudation from the lesion, as well as increased fluid in the skin, resulting in swelling and thickening. Meanwhile, the skin elasticity was mildly elevated, and the blood flow signal was enhanced.…”

An Overview of Different Techniques for Improving the Treatment of Pulmonary Hypertension Secondary in Systemic Sclerosis Patients

“…Systemic sclerosis (SSc) is a connective tissue disease characterized by immune and endothelial dysfunction, inflammation and fibrosis [1][2][3][4][5][6][7][8]. The main cause of death in SSc patients is the effect that collagen overproduction has on the internal organs, such as the pulmonary system [9][10][11][12].…”