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Tracking digital ulcers in systemic sclerosis: a feasibility study assessing lesion area in patient-recorded smartphone photographs
  1. Graham Dinsdale1,2,
  2. Tonia L Moore2,
  3. Joanne B Manning2,
  4. Andrea K Murray1,2,
  5. Ross Atkinson3,
  6. Karen Ousey4,
  7. Mark R Dickinson5,
  8. Christopher Taylor6,
  9. Ariane L Herrick1,2,7
  1. 1 Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  2. 2 Salford Royal NHS Foundation Trust, Salford, UK
  3. 3 Wounds Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
  4. 4 Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
  5. 5 Photon Science Institute, School of Physics and Astronomy, University of Manchester, Manchester, UK
  6. 6 Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
  7. 7 NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Graham Dinsdale, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK; graham.dinsdale{at}

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Systemic sclerosis (SSc)-related digital ulcers (DUs) are painful and disabling,1–3 and DU burden is often the primary outcome measure in clinical trials of SSc-related digital vasculopathy.4 This is despite several studies showing a lack of agreement between rheumatologists as to what constitutes a DU.5–8

Objective outcome measures of SSc-related DUs for tracking change over time are therefore urgently required for clinical practice and research studies. The application of digital planimetry to clinical DU photographs has shown the possibility of fine-grained measurement of DU characteristics (area).9 Our aims were to (1) demonstrate the feasibility of patients with SSc-related DUs/digital lesions photographing their lesions using smartphone cameras, and (2) use digital planimetry-style software analysis on images collected from patients to measure and track lesion area as a marker of healing or progression.

Patients with SSc-related digital lesions (judged to be ulcers by an experienced clinician) were asked to photograph …

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