Description

Kahaleh et al developed a modified skin scoring system for patients with scleroderma. The score measures skin thickening at 22 sites. The authors are from the University of South Carolina in Charleston.


 

Sites:

(1) face and head

(2) neck to clavicles

(3) anterior chest and breasts

(4) abdomen and flanks

(5) back

(6) buttocks

(7) left upper arm

(8) right upper arm

(9) left forearm

(10) right forearm

(11) left wrist to metacarpophalangeal (MCP) joints

(12) right wrist to MCP joints

(13) left MCP to proximal interphalangeal (PIP) joints

(14) right MCP to PIP joints

(15) left PIP joints to fingernails

(16) right PIP joints to fingernails

(17) left thigh

(18) right thigh

(19) left lower leg

(20) right lower leg

(21) left foot

(22) right foot

 

In each region the site with the most abnormal skin is graded.

 

Degree of Skin Thickening

Points

normal skin thickness and texture

0

thickened skin

1

thickened skin that cannot be pinched

2

hidebound skin

3

 

An exception to skin point assignment is used for the following sites:

(1) face and head

(2) left MCP to PIP

(3) right MCP to PIP

(4) left PIP to fingernails

(5) right PIP to fingernails.

These are graded 0, 2 and 3, with no grade 1. The skin in these sites can be normally thicker than in other sites.

 

skin score =

= SUM(points for all 22 sites)

 

Interpretation:

• minimum score: 0

• maximum score: 66

• The higher the score, the more extensive the skin involvement.

 

Limitations:

• A novice examiner needs to become familiar with the normal variability in skin thickness and texture.

 


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