Performance of ultra-high-frequency ultrasound in the evaluation of skin atrophy in patients with long-term oral glucocorticoid therapy in a tertiary rheumatology center

Abstract

Purpose

Ultra-high-frequency ultrasound (UHF-US) allows visualization of the epidermis, dermis, and subcutis and precise measurement of skin thickness. The aim of this study was to assess the performance and interobserver reliability of UHF-US for measuring skin thickness in patients with long-term systemic glucocorticoid (GC) therapy compared to patients without GC therapy or treated for a shorter period.

Materials and Methods

156 patients with known or suspected inflammatory rheumatic diseases underwent US evaluation for skin thickness by 3 experts in 3 anatomical sites (hand, distal, and proximal forearm). 87 patients were classified as “frequent users” who had received continuous oral GCs for at least one year or at least 3 years with various interruptions. 69 patients without any oral GC therapy in the past or treated for a shorter period were classified as “non-frequent users”.

Results

UHF-US allowed a precise measurement of skin thickness. Skin thickness at all 3 anatomical sites was significantly decreased in “frequent users” of GCs compared to “non-frequent users” (distal and proximal forearm: p < 0.001; hand: p < 0.05). At all 3 anatomical sites, skin thickness was decreased in patients with clinically assessed parchment-like skin compared to patients without parchment-like skin (distal and proximal forearm: p < 0.001; hand: p < 0.05). Interobserver variability was excellent [hand intraclass correlation coefficient (ICC) = 0.99; proximal forearm ICC = 0.85; distal forearm ICC = 0.84].

Conclusion

These data support the idea of UHF-US as an objective and reliable imaging tool for monitoring skin atrophy as adverse effects of GC therapy.

Zusammenfassung

Ziel

Die Ultrahochfrequenz-Sonografie (UHFS) ermöglicht die Visualisierung und Messung von Epidermis, Dermis und Subkutis. Ziel der vorliegenden Studie war die Evaluation der Leistungsfähigkeit und Interrater-Reliabilität der UHFS bei der Messung der Hautdicke bei Patienten mit systemischer Langzeit-Glukokortikoid-Therapie..

Material und Methode

Bei 156 Patienten mit bekannter oder vermuteter rheumatischer Erkrankung wurde die Hautdicke mittels UHFS an der Hand, am distalen und am proximalen Unterarm gemessen. 87 Patienten, die mindestens ein Jahr lang kontinuierlich oder mindestens 3 Jahre lang mit Unterbrechungen orale Glukokortikoide (GC) eingenommen hatten, wurden als „frequent Users‟ klassifiziert. 69 Patienten ohne oder mit kürzerer GC Therapie wurden als „non-frequent Users‟ klassifiziert.

Ergebnisse

Die UHFS ermöglichte eine präzise Messung der Hautdicke. An allen 3 anatomischen Stellen war die Hautdicke der „frequent Users‟ im Vergleich zu den „non-frequent Users‟ signifikant geringer (distaler und proximaler Unterarm: p < 0.001; Hand: p < 0.05). An allen 3 anatomischen Stellen war die Hautdicke bei Patienten, bei denen klinisch eine Pergamenthaut diagnostiziert worden war, im Vergleich zu Patienten ohne Pergamenthaut geringer (distaler und proximaler Unterarm: p < 0.001; Hand: p < 0.05). Die Interrater-Reliabilität war exzellent ([Intraklassen-Korrelationskoeffizient Hand (IKK) = 0,99; IKK proximaler Unterarm = 0,85; IKK distaler Unterarm = 0.84].

Schlussfolgerung

Die Daten der vorliegenden Studie legen nahe, dass die UHFS als objektives und reliables Bildgebungsverfahren zur Erfassung der GC-assoziierten Hautatrophie geeignet ist.

Keywords

Musculoskeletal System - Glucocorticoids - Skin atrophy

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