2010 Volume 72 Issue 6 Pages 612-616
The modified Rodnan total skin thickness score (m-Rodnan TSS) is generally used for quantitative evaluation of dermal sclerosis in patients with systemic scleroderma (scleroderma). Physicians with experience in treating scleroderma patients believe that this scoring method is excellent in terms of the reproducibility, although involvement of a subjective element in the examination is undeniable. Tissue strain imaging (TSI) with an ultrasonographic diagnostics system (Toshiba Medical Systems Inc.) has been introduced recently for quantitative analysis of the skin stiffness. The degree of stiffness of the dermis and subcutaneous tissue evaluated by this in vivo method, commonly known as strain measurement, at sites of dermal sclerosis in 11 scleroderma patients visiting the Department of Dermatology, Dokkyo Medical University Hospital, was compared with that measured at the corresponding sites in 18 healthy volunteers matched for gender and age. The strain measurement allows the elasticity of the dermal and deeper layers of the skin to be objectively and quantitatively expressed as the strain value. Strain values as measured by this method decrease with increasing degree of dermal sclerosis. On the side of the extended forearm, the strain value tended to be low in relation to the skin scores for the dermis and fat layers. In particular, there were significant differences in the scores for the dermis and fat layers between the scleroderma patients with high skin scores (2-3) and the healthy volunteers. These results indicate that the strain measurement is useful as an objective measurement technique, that can aid in the conventional evaluation by m-Rodnan TSS, of dermal sclerosis in scleroderma patients. It is considered that the strain measurement, the results of which are not influenced by the examiner's experience, may become useful in clinical practice for making the diagnosis of scleroderma and for judging the therapeutic efficacy for this disease in the future.
