Clinical utility of hypo- and hyperpigmentation of skin in diffuse cutaneous systemic sclerosis
Clinical utility of hypo- and hyperpigmentation of skin in diffuse cutaneous systemic sclerosis
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DOI：
10.1111/1756-185x.13049
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发表时间：
2017-06-01
影响因子：
2.5
通讯作者：
White, Douglas H. N.
中科院分区：
文献类型：
--
作者：
Solanki, Kamal K.;Hor, Cecil;White, Douglas H. N.
目的：皮肤受累是系统性硬化症（SSc）的早期表现。局部区域的“盐和胡椒皮肤”（S&P）可能会发展。我们假设S&P皮肤经常发生在弥漫性皮肤（DC）SSc，可用于其早期诊断，并可能与关节挛缩。方法：65例患者被招募进行这项研究。SSc的人口统计学特征从医院记录中确定。这些患者符合2013年美国风湿病学会/欧洲抗风湿联盟分类标准。患者进行了检查皮肤色素变化，改良Rodnan皮肤评分（mRSS），毛细血管扩张，钙质沉着，关节炎和关节挛缩和trustry.Results：65例（59名女性）被招募的中位年龄为62.87岁。44例为局限性皮肤SSc，16例为dcSSc，5例为硬皮病重叠综合征。多因素逐步Logistic回归分析表明，mRSS严重程度和挛缩的存在与dcSSc独立相关（P < 0.05）。S&P和mRSS严重程度之间的强正相关可以解释S&P在该分析中的不显著性。如果mRSS严重程度不包括在逻辑回归分析中，挛缩的存在和S&P（优势比= 15.1）显示与dcSSc亚型的显著（P < 0.01）独立关联。在Scl-70和抗RNA聚合酶抗体患者中，S&P皮肤和瘙痒相似。抗着丝粒抗体与S&P呈负相关（χ 2 = 7.89，P = 0.005）。结论：我们的研究表明S&P皮肤与dcSSc（69%）密切相关，增加了瘙痒和挛缩的风险。它的存在可以作为另一种临床工具，在早期诊断dcSSc。观察S&P皮肤变化不需要太多的培训。
Aim: Cutaneous involvement is an early manifestation of systemic sclerosis (SSc). Localized areas of 'salt and pepper skin' (S&P) may develop. We hypothesize that S&P skin occurs frequently in diffuse cutaneous (dc) SSc 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 SSc 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 SSc, 16 dcSSc, 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 dcSSc. 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 dcSSc 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 (chi(2) = 7.89, P = 0.005).Conclusion: Our study demonstrates strong association of S&P skin with dcSSc (69%), increased risk of pruritus and contractures. Its presence can be used as another clinical tool to diagnose dcSSc in early stages. Observing for S&P skin changes does not require much training.