title: High frequency ultrasound can detect improvement of lesions in juvenile localized scleroderma.
abstract: BACKGROUND
  Juvenile Localized Scleroderma (JLS) causes functional disabilities and cosmetic deformities. Evaluation and follow-up of lesions are mandatory to understand the disease evolution. The objective of this study is to evaluate the usefulness of skin ultrasonography (US) in monitoring the response to treatment in JLS.
  
  
  METHODS
  Ten patients (age: 101,7 ± 66,2 months; 7 M, 3 F) affected by juvenile onset LS underwent sequential US exams (at baseline and after 6 months). Skin thickness was measured by using high-frequency US (18 MHz). All patients were evaluated both clinically (modified Rodnan Skin Score, mRSS) and by US (dermal thickness) at baseline and at 6 months. At baseline, 6/10 patients received 3 pulses of corticosteroids (solumedrol 30 mg/kg/day for 3 consecutive days, then oral steroids (1mg/kg), and methotrexate s.c. (15 mg/mq/week). After 6 months, 1/6 was switched to mycophenolate mofetil (25 mg/kg/day) due to inefficacy of MTX; 4/10 did not receive any further therapy.
  
  
  RESULTS
  US showed a thicker dermis and a thinned hypodermis in the lesional skin areas in respect to the healthy ones (p < 0.05). After treatment, in seven patients a clinical improvement (decrease of mRSS) was found. In six of these patients, US showed a decrease of dermal thickness showing a correlation with clinical data. Three patients who did not receive drugs showed unmodified images and clinical findings.
  
  
  CONCLUSIONS
  US can help the assessment of skin and hypodermis in JLS and can detect an improvement of the lesions.
authors.affiliation: Department of Sperimental and Clinical Medicine, Section Rheumatology, AOUC, University of Florence , Florence , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porta
authors.forename: Olga
authors.initials: O
authors.lastname: Kaloudi
authors.forename: Alice
authors.initials: A
authors.lastname: Garzitto
authors.forename: Francesca
authors.initials: F
authors.lastname: Prignano
authors.forename: Francesca
authors.initials: F
authors.lastname: Nacci
authors.forename: Fernanda
authors.initials: F
authors.lastname: Falcini
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci Cerinic
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D012594:Scleroderma, Localized / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012867:Skin / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003879:Dermatologic Agents; D005938:Glucocorticoids; D008727:Methotrexate
keywords: Localized scleroderma; Ultrasound