Non-invasive imaging and clinical skin scores in juvenile localised scleroderma

Clare E Pain; Andrea Murray; Graham Dinsdale; Antonia Marsden; Joanne Manning; Phil Riley; Valentina Leone; Tania Amin; Francesco Zulian; Ariane L Herrick

doi:10.1093/rheumatology/kead380

Non-invasive imaging and clinical skin scores in juvenile localised scleroderma

Rheumatology (Oxford). 2023 Aug 2:kead380. doi: 10.1093/rheumatology/kead380. Online ahead of print.

Authors

Clare E Pain^{1

2}, Andrea Murray^{3

4}, Graham Dinsdale⁴, Antonia Marsden⁵, Joanne Manning⁴, Phil Riley⁶, Valentina Leone⁷, Tania Amin⁸, Francesco Zulian⁹, Ariane L Herrick^{3

4}

Affiliations

¹ Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
² Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
³ Division of Musculoskeletal & Dermatological Sciences, The University of Manchester, UK.
⁴ Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁵ Division of Population Health, Health Services Research and Primary Care, The University of Manchester, UK.
⁶ Department of Paediatric Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
⁷ Department of Pediatrics, Istituto Mediterraneo per i Trapianti Ismett IRCCS, Silicy, Italy.
⁸ Department of Paediatric Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK.
⁹ Department of Women's and Child's Health, University Hospital of Padua, Padua, Italy.

PMID: 37531286
DOI: 10.1093/rheumatology/kead380

Abstract

Objectives: To evaluate whether in juvenile localised scleroderma (JLS), non-invasive imaging can differentiate affected from non-affected skin and whether imaging correlates with a validated skin score (Localised Scleroderma Cutaneous Assessment Tool, LoSCAT).

Methods: 25 children with JLS were recruited into a prospective study and a single 'target' lesion selected. High frequency ultrasound (HFUS, measuring skin thickness), infrared thermography (IRT, skin temperature), laser Doppler imaging (LDI, skin blood flow) and multispectral imaging (MSI, oxygenation), were performed at four sites: two of affected skin (centre and inner edge of lesion) and two of non-affected skin (one cm from edge of lesion 'outer' and contralateral non-affected side), at 4 visits at 3 monthly intervals.

Results: Differences between affected and non-affected skin were detected with all 4 techniques. Compared with non-affected skin, affected skin was thinner (p< 0.001) with higher temperature (p< 0.001-0.006), perfusion (p< 0.001-0.039) and oxygenation (p< 0.001-0.028). Lesion skin activity (LoSCAT) was positively correlated with centre HFUS (r = 0.32; 95% CI [0.02, 0.61]; p= 0.036) and negatively correlated with centre LDI (r=-0.26; 95% CI [-0.49, -0.04]; p= 0.022). Lesion skin damage was positively correlated with centre and inner IRT (r = 0.43; 95% CI [0.19, 0.67]; p< 0.001, r = 0.36, 95% CI [0.12, 0.59]; p= 0.003, respectively) and with centre and inner LDI (r = 0.37; 95% CI [0.05, 0.69]; p= 0.024, r = 0.41; 95% CI [0.08, 0.74]; p= 0.015, respectively).

Conclusion: Non-invasive imaging can detect differences between affected and non-affected skin in JLS and may help to differentiate between activity (thicker, less well perfused skin) and damage (thinner, highly perfused skin).

Keywords: computerised skin score; high-frequency ultrasound; infrared thermography; juvenile localised scleroderma; laser Doppler; localised scleroderma cutaneous assessment tool; multispectral imaging.