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Clin Rheumatol. 2018 Jun;37(6):1555-1561. doi: 10.1007/s10067-018-3986-5. Epub 2018 Mar 10.

Ultrasound characterization of cutaneous ulcers in systemic sclerosis.

Author information

1
Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt.
2
Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
3
Department of Radiology and Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.
4
Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
5
Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
6
Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. dan@furst.us.com.
7
Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, Florence, Italy. dan@furst.us.com.
8
Department of Rheumatology, Unversity of Washington, Seattle, WA, USA. dan@furst.us.com.

Abstract

Skin ulcers in scleroderma (SSc) patients are considered a major challenge, both in clinical assessment and treatment decisions. The objective of our study is to assess ultrasonographic (US) morphology of skin ulcers in SSc patients and evaluate if US will be of value in enhancing our clinical information and influence our management plans. We examined a convenience sample of 21 skin ulcers reported in 10 SSc patients by US. We used a previously published US definition of normal skin and developed a preliminary US definition of skin ulcer. Skin ulcers were evaluated by gray scale (GS) and power Doppler (PD) and separated into ulcer and non-ulcer lesions; pain and ulcer measures were obtained using visual analogue scales (VAS). Lesions were characterized and ulcers were clinically and sonographically measured. Ten patients presenting with 21 skin lesions were examined by US. Applying our US definition of skin ulcer, all ulcers were available to measure by ultrasound. Eight lesions were sonographically defined as ulcers, and 13 lesions as non-ulcer lesions. Three ulcers had high PD signals suggestive of infection requiring antibiotic treatment and were monitored for 2 weeks showing a decrease of the pain, VAS, and PD signals. Five lesions showed subclinical calcinosis. This is the first study to show the promising role of US in defining skin ulcers of SSc patients. US may support the assessment of morphology and extent of skin ulcers in SSc and can be a helpful tool for detecting underlying pathology.

KEYWORDS:

Scleroderma; Skin imaging; Skin ulcers; Skin ultrasound; Ultrasound; Ultrasound dermatology; Ultrasound morphea

PMID:
29525847
DOI:
10.1007/s10067-018-3986-5
[Indexed for MEDLINE]

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