title: Quantification of hardness, elasticity and viscosity of the skin of patients with systemic sclerosis using a novel sensing device (Vesmeter): a proposal for a new outcome measurement procedure.
abstract: OBJECTIVE
  No objective method to measure skin involvement in SSc has been established. We developed a novel method using a computer-linked device to simultaneously quantify physical properties of the skin such as hardness, elasticity and viscosity.
  
  
  METHODS
  Skin hardness was calculated by measuring the depth of an indenter pressed onto the skin. The Voigt model was used to calculate skin elasticity, viscosity, visco-elastic ratio and relaxation time by analysing the waveform of skin surface behaviour. The results were compared with the modified Rodnan skin score (mRSS) obtained at 17 sites on the bodies of 20 SSc patients and 20 healthy controls. A functional assessment questionnaire was administered to determine how skin hardness represents a patient's disability. We also examined intra- and inter-observer variability to determine the reliability of this method.
  
  
  RESULTS
  The crude hardness obtained with this device correlated well with the standard hardness specified by the American Society for Testing and Materials (ASTM, r = 0.957). A close relationship between hardness and total mRSS was also observed (r = 0.832). Skin elasticity correlated positively, and relaxation time negatively with mRSS. Functional disability correlated more closely with skin hardness (r = 0.643) than with mRSS (r = 0.517). Intra- and inter-observer variabilities were 7.63 and 19.76%, respectively, which were lower than those reported for mRSS.
  
  
  CONCLUSIONS
  Increases in hardness and elasticity as well as shortening of relaxation time constitute objective characteristics of skin involvement in SSc. The system devised by us proved to be able to assess skin abnormalities of SSc with high reliability.
authors.affiliation: Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kuwahara
authors.forename: Y
authors.initials: Y
authors.lastname: Shima
authors.forename: D
authors.initials: D
authors.lastname: Shirayama
authors.forename: M
authors.initials: M
authors.lastname: Kawai
authors.forename: K
authors.initials: K
authors.lastname: Hagihara
authors.forename: T
authors.initials: T
authors.lastname: Hirano
authors.forename: J
authors.initials: J
authors.lastname: Arimitsu
authors.forename: A
authors.initials: A
authors.lastname: Ogata
authors.forename: T
authors.initials: T
authors.lastname: Tanaka
authors.forename: I
authors.initials: I
authors.lastname: Kawase
mesh_terms: D000328:Adult; D000368:Aged; D004548:Elasticity; D005260:Female; D006244:Hardness; D006245:Hardness Tests / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D012867:Skin / Q000503:physiopathology*; D014783:Viscosity