{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:19:45Z","timestamp":1777342785080,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: To assess skin involvement in a cohort of patients with systemic sclerosis (SSc) by comparing results obtained from modified Rodnan skin score (mRSS), durometry and ultra-high frequency ultrasound (UHFUS). Methods: SSc patients were enrolled along with healthy controls (HC), assessing disease-specific characteristics. Five regions of interest were investigated in the non-dominant upper limb. Each patient underwent a rheumatological evaluation of the mRSS, dermatological measurement with a durometer, and radiological UHFUS assessment with a 70 MHz probe calculating the mean grayscale value (MGV). Results: Forty-seven SSc patients (87.2% female, mean age 56.4 years) and 15 HC comparable for age and sex were enrolled. Durometry showed a positive correlation with mRSS in most regions of interest (p = 0.025, \u03c1 = 0.34 in mean). When performing UHFUS, SSc patients had a significantly thicker epidermal layer (p &lt; 0.001) and lower epidermal MGV (p = 0.01) than HC in almost all the different regions of interest. Lower values of dermal MGV were found at the distal and intermediate phalanx (p &lt; 0.01). No relationships were found between UHFUS results either with mRSS or durometry. Conclusions: UHFUS is an emergent tool for skin assessment in SSc, showing significant alterations concerning skin thickness and echogenicity when compared with HC. The lack of correlations between UHFUS and both mRSS and durometry suggests that these are not equivalent techniques but may represent complementary methods for a full non-invasive skin evaluation in SSc.<\/jats:p>","DOI":"10.3390\/diagnostics13081495","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T02:05:31Z","timestamp":1682042731000},"page":"1495","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Multiparametric Skin Assessment in a Monocentric Cohort of Systemic Sclerosis Patients: Is There a Role for Ultra-High Frequency Ultrasound?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4788-5729","authenticated-orcid":false,"given":"Marco","family":"Di Battista","sequence":"first","affiliation":[{"name":"Rheumatology Unit, University of Pisa, 56124 Pisa, Italy"},{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Barsotti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saverio","family":"Vitali","sequence":"additional","affiliation":[{"name":"Radiology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Palma","sequence":"additional","affiliation":[{"name":"Radiology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giammarco","family":"Granieri","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Oranges","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0842-5372","authenticated-orcid":false,"given":"Giacomo","family":"Aringhieri","sequence":"additional","affiliation":[{"name":"Radiology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Dini","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Della Rossa","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-4559","authenticated-orcid":false,"given":"Emanuele","family":"Neri","sequence":"additional","affiliation":[{"name":"Radiology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Romanelli","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Mosca","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"ref_1","first-page":"3","article-title":"One year in review 2021: Systemic sclerosis","volume":"39","author":"Barsotti","year":"2021","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"D\u2019Oria, M., Gandin, I., Riccardo, P., Hughes, M., Lepidi, S., Salton, F., Confalonieri, P., Confalonieri, M., Tavano, S., and Ruaro, B. (2023). Correlation between Microvascular Damage and Internal Organ Involvement in Scleroderma: Focus on Lung Damage and Endothelial Dysfunction. Diagnostics, 13.","DOI":"10.3390\/diagnostics13010055"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"v44","DOI":"10.1093\/rheumatology\/ken309","article-title":"Skin involvement in systemic sclerosis","volume":"47","author":"Foeldvari","year":"2008","journal-title":"Rheumatology"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tieu, A., Chaigne, B., Dunogu\u00e9, B., Dion, J., R\u00e9gent, A., Casadevall, M., Cohen, P., Legendre, P., Terrier, B., and Costedoat-Chalumeau, N. (2022). Autoantibodies versus Skin Fibrosis Extent in Systemic Sclerosis: A Case-Control Study of Inverted Phenotypes. Diagnostics, 12.","DOI":"10.3390\/diagnostics12051067"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5301\/jsrd.5000231","article-title":"Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis","volume":"2","author":"Khanna","year":"2017","journal-title":"J. Scleroderma Relat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1002\/art.23564","article-title":"Validity, reliability, and feasibility of durometer measurements of scleroderma skin disease in a multicenter treatment trial","volume":"59","author":"Merkel","year":"2008","journal-title":"Arthritis Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/acr.23597","article-title":"Ultrasonography for the assessment of skin in systemic sclerosis: A systematic review","volume":"71","author":"Santiago","year":"2019","journal-title":"Arthritis Care Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1093\/rheumatology\/kez439","article-title":"Performance of ultra-high-frequency ultrasound in the evaluation of skin involvement in systemic sclerosis: A preliminary report","volume":"59","author":"Naredo","year":"2020","journal-title":"Rheumatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1136\/annrheumdis-2013-204424","article-title":"2013 classification criteria for systemic sclerosis: An American college of rheumatology\/European league against rheumatism collaborative initiative","volume":"72","author":"Khanna","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_10","first-page":"202","article-title":"Scleroderma (systemic sclerosis): Classification, subsets and pathogenesis","volume":"15","author":"LeRoy","year":"1988","journal-title":"J. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1007\/s00296-011-1993-9","article-title":"The correlation between durometer score and modified Rodnan skin score in systemic sclerosis","volume":"32","author":"Moon","year":"2012","journal-title":"Rheumatol. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"104006","DOI":"10.1016\/j.mvr.2020.104006","article-title":"State-of-the-art technologies provide new insights linking skin and blood vessel abnormalities in SSc-related disorders","volume":"130","author":"Dinsdale","year":"2020","journal-title":"Microvasc. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/rheumatology\/kem307","article-title":"High-frequency ultrasound of skin involvement in systemic sclerosis reflects oedema, extension and severity in early disease","volume":"47","author":"Hesselstrand","year":"2008","journal-title":"Rheumatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1136\/ard.2009.114843","article-title":"High frequency ultrasound measurement of digital dermal thickness in systemic sclerosis","volume":"69","author":"Kaloudi","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1186\/s13075-015-0853-5","article-title":"High frequency ultrasound of skin involvement in systemic sclerosis\u2014A follow-up study","volume":"17","author":"Hesselstrand","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13075-017-1270-8","article-title":"Subclinical dermal involvement is detectable by high frequency ultrasound even in patients with limited cutaneous systemic sclerosis","volume":"19","author":"Sulli","year":"2017","journal-title":"Arthritis Res. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/s13075-018-1686-9","article-title":"High-frequency ultrasound of the skin in systemic sclerosis: An exploratory study to examine correlation with disease activity and to define the minimally detectable difference","volume":"20","author":"Li","year":"2018","journal-title":"Arthritis Res. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/art.22093","article-title":"Durometry for the assessment of skin disease in systemic sclerosis","volume":"55","author":"Kissin","year":"2006","journal-title":"Arthritis Rheumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151954","DOI":"10.1016\/j.semarthrit.2022.151954","article-title":"Ultrasound and elastography in the assessment of skin involvement in systemic sclerosis: A systematic literature review focusing on validation and standardization \u2013 WSF Skin Ultrasound Group","volume":"52","author":"Santiago","year":"2022","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00296-020-04761-8","article-title":"High-resolution ultrasound imaging of skin involvement in systemic sclerosis: A systematic review","volume":"41","author":"Sobolewski","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"V53","DOI":"10.1093\/rheumatology\/kex202","article-title":"Assessment of skin involvement in systemic sclerosis","volume":"56","author":"Bae","year":"2017","journal-title":"Rheumatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"867","DOI":"10.3899\/jrheum.200234","article-title":"High-frequency ultrasound assessment of systemic sclerosis skin involvement: Intraobserver repeatability and relationship with clinician assessment and dermal collagen content","volume":"48","author":"Flower","year":"2021","journal-title":"J. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1186\/s13075-020-02285-x","article-title":"Ultrasound assessment of skin thickness and stiffness: The correlation with histology and clinical score in systemic sclerosis","volume":"22","author":"Chen","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1007\/s00296-019-04315-7","article-title":"Correlation between circulating fibrocytes and dermal thickness in limited cutaneous systemic sclerosis patients: A pilot study","volume":"39","author":"Ruaro","year":"2019","journal-title":"Rheumatol. Int."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/8\/1495\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:20:20Z","timestamp":1760124020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/8\/1495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,21]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["diagnostics13081495"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13081495","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,21]]}}}