Background/Purpose: Skin involvement is one of the early features of scleroderma and an important predictor of internal organ involvement and mortality. Skin fibrosis alters the normal dermal architecture and compromises biomechanical skin properties. Therefore, biomechanical parameters can not only provide quantitative assessment of the disease severity, but also help physicians monitor disease progression. However, no systemic review has summarized recent findings about the role of biomechanics in the assessment of scleroderma. This systemic review evaluates the effectiveness of biomechanical tools in diagnosing and tracking skin diseases for patients with scleroderma.

Methods: A comprehensive search of PubMed/Medline and Cochrane databases was performed until May, 2019. In addition, a manual search was conducted in which reference lists of selected articles were screened to include relevant ones. Several related synonyms were used, including biomechanics, scleroderma and assessment. Selection criteria included studies that were comprised of participants with either limited cutaneous (lcSSc) or diffuse cutaneous systemic sclerosis (dcSSc), with a sample size greater than 20, and investigated at least one biomechanical property of the skin.

Results: 46 relevant studies were identified and 12 articles were eligible to be included in this review, with a total of 212 participants. The techniques developed for quantitative measurements of skin properties included durometer (2 articles), indentation (2 articles), suction method (3 articles), surface wave technique (2 articles), ultrasound (1 article), atomic force microscopy (1 article) and photoacoustic elastic tomography (1 article). All studies reported at least one skin biomechanical property that was significantly different in patients with scleroderma compared to normal controls. The skin of patients with scleroderma was found to have decreased extensibility (p< 0.05), increased stiffness (p< 0.03), and decreased skin viscoelasticity (p < 0.03 in patients with dcSSc). Besides, skin sclerosis was associated with smaller difference in viscoelasticity among different anatomic sites (p < 0.05). One study reported that some anatomic sites of patients already showed significantly different biomechanical properties (p < 0.05), even with a modified Rodnan score of 0, suggesting that biomechanical measurements could be helpful for diagnosis at early stages and might provide more sensitive assessment of disease progression.

Conclusion: Current evidence suggests that biomechanical properties of the skin can be used as a marker for diagnosis and monitoring of disease progression in scleroderma. Compared to the modified Rodnan skin score, they may provide a more objective, reliable and sensitive way to evaluate skin disease. Rigorous and large-scale randomized control trials are warranted to further assess the clinical value of tracking skin biomechanical properties in patients with scleroderma.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biomechanical-properties-of-skin-for-assessment-of-scleroderma-a-systemic-review/