HF-Ultrasonography to Quantify Skin Atrophy in Patients with Inflammatory Rheumatic Diseases Treated with Courses of Glucocorticoids

TL;DR

This study uses high-frequency ultrasonography to measure skin thinning in patients with rheumatic diseases who take long-term steroid treatment.

Contribution

The study introduces HF-US as a precise method to quantify systemic GC-induced skin atrophy in IRD patients.

Findings

HF-US detected significant skin atrophy in GC-treated IRD patients at multiple body sites.

Skinfold calipers showed significant differences only at the back of the hand.

All three body regions showed significant differences in cutaneous thickness via HF-US.

Abstract

Background: Prolonged courses of glucocorticoids (GCs) for patients suffering from inflammatory rheumatic diseases (IRDs) are associated with adverse effects. High-frequency ultrasonography (HFUS) has been utilized to quantify skin changes during short-term topical GC treatment. We aimed to quantify skin atrophy in IRD patients treated systemically with prolonged courses of GCs. Methods: We performed a cross-sectional study comparing patients with IRDs and GC treatment who presented with clinically evident skin atrophy to a matched cohort (1:1) without IRDs and GC treatment. Skinfold measurements, utilizing a standardized caliper, and B-mode HFUS images, utilizing an 18 MHz linear sonography probe, were acquired at back-of-hand, cubital, and dorsal midfoot regions and then compared between both groups. Results: A total of 53 GC-treated IRD patients (33 (62%) women, mean age 66.4 (±10.0) years, GC treatment median 8.0 (1.0–47.0) years) were compared to 53 subjects without IRDs and GC treatment (32 (60%) women, 65.9 (±11.3) years). Skinfold thickness measured at the back of hands [1.7 (±0.4) vs. 2.1 (±0.5) mm, p < 0.001], but not at the cubital [6.7 (±2.7) vs. 7.1 (±3.0) mm] or dorsal midfoot [3.6 (±3.7) vs. 4.1 (±3.4) mm] areas, showed a significant difference between the groups. In comparison, all areas displayed statistically significant different cutaneous thickness in the evaluation by HFUS: hand 0.66 (±0.12) vs. 0.82 (±0.18), p < 0.001; cubital 0.86 (±0.15) vs. 1.00 (±0.21), p < 0.001; and midfoot 0.76 (±0.16) vs. 0.94 (±0.18), p < 0.001. Conclusions: This study revealed significantly lower values in the measured cutaneous thickness by HFUS for GC-treated patients with IRDs compared to persons without IRD and GC treatment.

Figures