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High frequency ultrasound measurement of digital dermal thickness in systemic sclerosis
  1. Olga Kaloudi1,
  2. Francesca Bandinelli1,
  3. Emilio Filippucci2,
  4. Maria Letizia Conforti1,
  5. Irene Miniati1,
  6. Serena Guiducci1,
  7. Francesco Porta1,
  8. Antonio Candelieri3,
  9. Domenico Conforti3,
  10. Genesio Grassiri4,
  11. Walter Grassi2,
  12. Marco Matucci-Cerinic1
  1. 1Department of Biomedicine, Division of Rheumatology AOUC, Centre Denothe, University of Florence, Florence, Italy
  2. 2Division of Rheumatology, University of Marche, Jesi, Ancona, Italy
  3. 3Laboratory of Decision Engineering for Health Care Delivery, Department of Electronics, Informatics and Systems, University of Calabria, Cosenza, Italy
  4. 4Esaote, Genoa, Italy
  1. Correspondence to Olga Kaloudi, Department of Biomedicine, Division of Rheumatology AOUC, Centre Denothe, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, Florence 50139, Italy; olgakaloudi{at}


Background Currently, assessment of dermal thickness in systemic sclerosis (SSc) is performed by palpation and assessment using the modified Rodnan skin score (mRSS).

Objective To verify whether high frequency ultrasound (US) may be a reliable and a reproducible method to measure digital dermal thickness.

Methods In 70 patients with SSc, skin thickness was evaluated with US by 2 observers at 2 different sites on the second digit of the dominant limb to determine the interobserver variability. Patients and controls were examined twice by the first observer for intraobserver variability. Patients were divided into three subgroups according to the phase of the disease (oedematous, fibrotic or atrophic).

Results At both examined areas, US showed a significant dermal thickening (p<0.001) in the whole group of patients with SSc. A low intraobserver and interobserver variability was found. A highly significant correlation between the global mRSS and the local dermal thickness at the two examined sites (p=0.032, p=0.021) was detected. Skin thickness was significantly higher in the oedematous than in the fibrotic group (p<0.001) and significantly higher in the fibrotic and the oedematous group (p<0.001) than in the atrophic group (p<0.002).

Conclusions US is a reliable tool giving reproducible results, and is able to detect digital dermal thickening in SSc.

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  • Funding This study was supported by the technical equipment generously provided by Esaote.

  • Ethics approval This study was conducted with the approval of the Florence Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent Obtained.