Ann Rheum Dis 64:1524-1526 doi:10.1136/ard.2005.038935
  • Letter

Distal degeneration of sensory and autonomic cutaneous nerve fibres in systemic sclerosis

  1. V Provitera1,
  2. M Nolano1,
  3. N Pappone2,
  4. C di Girolamo3,
  5. A Stancanelli1,
  6. F Lullo1,
  7. C Crisci4,
  8. L Santoro5
  1. 1Neurology Division, “Salvatore Maugeri” Foundation, IRCCS, Centre of Telese Terme, Italy
  2. 2Rheumatology Division, “Salvatore Maugeri” Foundation, IRCCS, Centre of Telese Terme, Italy
  3. 3Rheumatology Unit, “G Rummo” Hospital, Benevento, Italy
  4. 4Clinic Centre, Private Hospital for Rehabilitation, Naples, Italy
  5. 5Department of Neurological Sciences, University of Naples “Federico II”, Italy
  1. Correspondence to:
    Dr V Provitera
    Neurology Division, “Salvatore Maugeri” Foundation, IRCCS, Via Bagni Vecchi 1, 82037, Telese Terme (BN), Italy;
  • Accepted 30 March 2005

We studied innervation and dermal vasculature in affected and apparently normal skin of sclerodermic patients to evaluate the involvement of different nerve fibre groups and to determine a possible correlation with vascular damage in this disease. Immunohistochemical analysis and confocal microscopic examination of skin biopsy samples were used.


We obtained 3 mm punch skin biopsy samples from the distal thigh and distal leg in 11 consecutive 34–70 year old female patients with systemic sclerosis (SSc), identified by the American College of Rheumatology classification criteria.1 We excluded patients who had been exposed to potentially neurotoxic exogenous or endogenous conditions. The skin appeared sclerotic in 4/11 patients in the leg and in 3/11 in the thigh (table 1). In four patients a further skin sample from fingertip was taken to evaluate myelinated fibres. None of the patients complained of sensory disturbances, and neurological and neurophysiological evaluations were normal except in two patients, in whom a conduction velocity study showed the presence of an entrapment syndrome. Patient morphological findings were compared with data …