Clinical skin thickening following spinal cord injury studied by histopathology

Dermatohistopathologic studies were performed in persons with spinal cord injury to evaluate the clinical observation of skin thickening. Twenty subjects were included in a prospective acute study and 59 subjects in a chronic study. Skin biopsies of the lower lateral thigh were studied by routine histopathology. The most common histopathologic findings included dermal fibrosis and perivascular inflammatory infiltrate. Dermal fibrosis was already identified within two months after injury in the acute study. In chronic patients, dermal fibrosis was found in 65 percent of persons with tetraplegia compared to 25 percent with paraplegia (p = .0038). Perivascular inflammatory infiltrate was less frequent and its presence was not associated with the level of injury. Histopathologic findings were generally not as prominent as the clinical picture. This disparity may be explained by a combination of edema and dermal fibrosis. Loss of autonomic nervous system control or other neuroendocrine dysfunction is suspected as a causative factor in the pathogenesis of these findings.