Association of skin hyperpigmentation disorders with digital ulcers in systemic sclerosis: Analysis of a cohort of 239 patients
Association of skin hyperpigmentation disorders with digital ulcers in systemic sclerosis: Analysis of a cohort of 239 patients
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DOI：
10.1016/j.jaad.2018.07.033
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发表时间：
2019-02-01
影响因子：
13.8
通讯作者：
Seneschal, Julien
中科院分区：
文献类型：
--
作者：
Leroy, Vaianu;Henrot, Pauline;Seneschal, Julien
背景：系统性硬化症（SSc）的皮肤色素沉着疾病在文献中的描述很少。然而，他们可以是一个诊断和/或严重程度marker.Objectives：To assess the association between patients with SSc.Methods：A total of 5 patterns of skin pigmentation disorders were defined：diffuse hyperpigmentation; hyperpigmentation of sun-exposed areas; hypopigmentation of the head，neck，and/or upper part of the chest; acral hypopigmentation; and diffuse hypopigmentation.Results：共纳入239例患者; 88例患者（36.8%）有以下皮肤色素沉着疾病：38.6%（n = 34）和27.3%（n = 24）的患者分别有弥漫性色素沉着过度和日光暴露区色素沉着过度，10.2%（n = 9）的患者有面部、颈部和/或胸部色素减退;弥漫性色素减退12.5%（n = 11），肢端色素减退17%（n = 15）。在单变量分析中，弥漫性色素沉着过度与弥漫性SSc（P = 0.001）、改良Rodnan皮肤评分增加（P = 0.001）和雷诺现象持续时间缩短（P = 0.002）相关，但在多变量分析中无关。此外，弥漫性色素沉着与指端溃疡有关（P = .005），经多变量分析证实（优势比，2.96; 95%可信区间，1.28-6.89）。局限性：这是一项单中心回顾性研究，对SSc患者进行队列研究。皮肤色素沉着疾病的筛查可能有助于SSc患者的管理，以确定那些具有发展指溃疡的高风险的患者，这是SSc血管受累的症状。
Background: Skin pigmentation disorders in systemic sclerosis (SSc) have been sparsely described in the literature. Nevertheless, they could be a diagnostic and/or severity marker.Objectives: To assess the association between pigmentation disorders and systemic involvement in patients with SSc.Methods: A total of 5 patterns of skin pigmentation disorders were defined: diffuse hyperpigmentation; hyperpigmentation of sun-exposed areas; hypopigmentation of the head, neck, and/or upper part of the chest; acral hypopigmentation; and diffuse hypopigmentation.Results: A total of 239 patients were included; 88 patients (36.8%) had skin pigmentation disorders as follows: diffuse hyperpigmentation and hyperpigmentation of sun-exposed areas in 38.6% (n = 34) and 27.3% (n = 24) of patients, respectively; hypopigmentation of the face, neck, and/or chest in 10.2% of patients (n = 9); diffuse hypopigmentation in 12.5% (n = 11); and acral hypopigmentation in 17% (n = 15). Diffuse hyperpigmentation was associated with diffuse SSc (P = .001), increased modified Rodnan skin score (P = .001), and shorter duration of Raynaud phenomenon (P = .002) in univariate analysis but not in multivariate analysis. Moreover, diffuse hyperpigmentation was associated with digital ulcers (P = .005), as confirmed by multivariate analysis (odds ratio, 2.96; 95% confidence interval, 1.28-6.89).Limitations: This was a single-center retrospective study of a cohort of patients with SSc.Conclusion: Screening for skin pigmentation disorders could be useful in the management of patients with SSc to identify those with a high risk of development of digital ulcers, which is a symptom of vascular involvement in SSc.