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Ultrasound Assessment of Subcutaneous Compressibility: A Potential Adjunctive Diagnostic Tool in Eosinophilic Fasciitis

Kissin, Eugene Y. MD*; Garg, Amit MD; Grayson, Peter C. MD, MSc; Dubreuil, Maureen MD*; Vradii, Diana MD*; York, Michael MD*; Simms, Robert W. MD*

JCR: Journal of Clinical Rheumatology: October 2013 - Volume 19 - Issue 7 - p 382–385
doi: 10.1097/RHU.0000000000000020
Original Articles

Background Eosinophilic fasciitis (EF) is an autoimmune, fibrotic disorder described initially with scleroderma-like skin changes where deep soft tissue sampling that includes fascia is frequently felt to be necessary to confirm the diagnosis.

Objective The objective of this study was to distinguish forearm involvement by EF from other fibrosing diseases and from control subjects with normal skin and fascia using B-mode ultrasound.

Methods A cross-sectional study over a 4-year period in which clinically involved forearm skin of consecutive patients with EF (n = 12), diabetic cheiroarthropathy (n = 8), diffuse systemic sclerosis (n = 23), and control subjects (n = 8) was evaluated by 12-MHz, B-mode ultrasound for degree of subcutaneous tissue compressibility, and this finding was compared with the criterion standard of clinical diagnostic criteria for each disease process.

Results Subcutaneous compressibility in EF was significantly reduced when compared with diffuse systemic sclerosis and with control subjects. Subcutaneous thinning was observed in some patients with EF (4/12), diabetic cheiroarthropathy (4/8), and diffuse systemic sclerosis (6/23), but not in control subjects. Diabetic cheiroarthropathy and diffuse systemic sclerosis patients with subcutaneous thinning had less than 20% subcutaneous compressibility, whereas only 1 of 12 EF patients had compressibility of more than 20% regardless of subcutaneous thinning.

Conclusions A 12-MHz, B-mode ultrasound may be used to measure subcutaneous compressibility, thereby serving as an adjunct tool in distinguishing EF from diffuse systemic sclerosis, especially when tissue sampling is less feasible or when the result of tissue sampling is equivocal.

This innovative use of ultrasound suggests that patients with eosinophilic fasciitis have less compressibility of subcutaneous tissue than scleroderma and other controls.

From the *Division of Rheumatology and †Department of Dermatology, Boston University School of Medicine, Boston, MA; and ‡National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD.

This study has no sources of support.

The authors declare no conflict of interest.

Correspondence: Eugene Y. Kissin, MD, 72 East Concord Str, E-506 Arthritis Center, Boston University School of Medicine, Boston, MA 02118. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.