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Clinical utility of hypo‐ and hyperpigmentation of skin in diffuse cutaneous systemic sclerosis
Author(s) -
Solanki Kamal K.,
Hor Cecil,
Chang Winston S. J.,
Frampton Christopher,
White Douglas H. N.
Publication year - 2017
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13049
Subject(s) - medicine , dermatology , scleroderma (fungus) , muscle contracture , sclerodactyly , odds ratio , logistic regression , rheumatology , calcinosis , rheumatism , polyarthritis , gastroenterology , arthritis , surgery , pathology , calcification , inoculation
Aim Cutaneous involvement is an early manifestation of systemic sclerosis ( SS c). Localized areas of ‘salt and pepper skin’ (S&P) may develop. We hypothesize that S&P skin occurs frequently in diffuse cutaneous (dc) SS c which can be used in its early diagnosis and may correlate with joint contractures. Methods Sixty‐five patients were recruited for this study. The demographic profiles of SS c were ascertained from hospital records. These patients fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria. Patients were examined for skin pigmentary changes, modified Rodnan skin score ( mRSS ), telengiectasias, calcinosis, arthritis and joint contractures and pruritus. Results Sixty‐five patients (59 female) were recruited with median age of 62.87 years. Forty‐four had limited cutaneous SS c, 16 dc SS c, five had scleroderma overlap syndrome. Multivariate stepwise logistic regression indicated that mRSS severity and the presence of contractures were independently ( P < 0.05) associated with dc SS c. The strong positive association between S&P and mRSS severity may explain the non‐significance of S&P in this analysis. If mRSS severity is not included in the logistic regression analysis, the presence of contractures and S&P (odds ratio = 15.1) show significant ( P < 0.01) independent associations with the dc SS c subtype. S&P skin and pruritus were similar in patients with Scl‐70 and anti‐ RNA polymerase antibodies. Anti‐centromere antibodies were negatively associated with S&P (χ 2 = 7.89, P = 0.005). Conclusion Our study demonstrates strong association of S&P skin with dc SS c (69%), increased risk of pruritus and contractures. Its presence can be used as another clinical tool to diagnose dc SS c in early stages. Observing for S&P skin changes does not require much training.