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Increased pigmentation in scleroderma

J E Pope1, D T Shum, R Gottschalk

  • 1Department of Medicine, University of Western Ontario, London, Canada.

The Journal of Rheumatology
|November 1, 1996
PubMed
Summary
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Increased skin pigmentation in scleroderma (systemic sclerosis, SSc) may stem from subclinical SSc changes, not adrenal factors. Pigmented skin showed subtle SSc alterations, particularly in diffuse SSc patients.

Area of Science:

  • Dermatology
  • Rheumatology
  • Endocrinology

Background:

  • Patients with scleroderma (systemic sclerosis, SSc) often exhibit increased skin pigmentation, even in clinically unaffected areas.
  • The cause of this pigmentation, whether due to subclinical skin changes or systemic factors like adrenocorticotropic hormone (ACTH), remains unclear.

Purpose of the Study:

  • To investigate whether increased pigmentation in clinically uninvolved skin of SSc patients is associated with subclinical sclerodermatous changes.
  • To determine if elevated ACTH levels contribute to the observed pigmentation.

Main Methods:

  • Skin biopsies were obtained from pigmented and non-pigmented clinically normal skin sites in SSc patients.
  • Biopsies were histopathologically examined for dermal and epidermal alterations.

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  • Cosyntropin stimulation tests were performed to assess adrenal function (ACTH and cortisol levels).

    • Main Results:

    • Six patients with diffuse SSc (dSSc) and four with limited SSc (ISSc) underwent biopsy.
    • Pigmented skin specimens showed increased epidermal melanin and/or pigmentary incontinence with more dermal melanophages, especially in dSSc patients.
    • Cosyntropin stimulation tests yielded normal results, with no significant differences observed between SSc subtypes or pigmentation groups.

    Conclusions:

    • Clinically uninvolved skin in SSc patients can exhibit subtle, abnormal sclerodermatous changes, particularly evident in pigmented areas.
    • The observed pigmentation is likely related to these subclinical SSc changes rather than adrenal insufficiency.
    • Pathological differentiation between pigmented and unpigmented skin in SSc is limited, primarily to melanin content and pigmentary incontinence.