Cutaneous Hypoxia in Patients With Systemic Sclerosis (Scleroderma)

doi:10.1001/archderm.1988.01670090035007

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Vol. 124 No. 9, September 1988

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Cutaneous Hypoxia in Patients With Systemic Sclerosis (Scleroderma)

Judith L. Silverstein, MD; Virginia D. Steen, MD; Thomas A. Medsger, Jr, MD; Vincent Falanga, MD

Arch Dermatol. 1988;124(9):1379-1382.

Abstract

• Measurement of transcutaneous oxygen pressure (Tcpo₂)is an established and noninvasive way of assessing cutaneoushypoxia. Since the degree of oxygénation modulates fibroblastgrowth and synthesis, we investigated the presence of cutaneoushypoxia in patients with systemic sclerosis (SS). We measuredTcpo₂ of the involved skin of the dorsal aspect of the forearmin 33 patients with SS and 16 control individuals (normal subjectsand patients with Raynaud's disease). The degree of forearmskin thickness was assessed clinically as mild, moderate, orsevere. The Tcpo₂ measurements were obtained at a sensor temperatureof 44°C, which causes maximal vasodilation and eliminatesthe variables associated with vascular tone. Measurements wererecorded while patients were breathing room air or 31% oxygendelivered by a Ventimask system (Baxter Healthcare, Ocala, Fla).We also measured the Tcpo₂ of the medial aspect of the arm whenthis site was uninvolved. We found that sclerodermatous skinis hypoxic when compared with the uninvolved skin of patientswith SS or control individuals. The Tcpo₂ values were indirectlyrelated to skin thickness; thus, patients whose skin was severelythickened had the lowest Tcpo₂ values. There was no correlationof Tcpo₂ values with pulmonary function tests or arterial oxygenpressure. The Tcpo₂ levels of patients with Raynaud's diseasedid not differ from other control individuals. The administrationof oxygen increased Tcpo₂ readings in patients with SS to normalvalues. We conclude that the thickened skin of patients withSS is hypoxic and suggest that Tcpo₂ measurements may be helpfulin objectively assessing the degree of skin thickness. The hypoxiademonstrated in SS skin may play a role in the modulation ofdermal fibroblast proliferation and synthetic activity.

(Arch Dermatol 1988;128:1379-1382)

Author Affiliations

From the Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine (Dr Falanga) and the Departments of Dermatology (Dr Silverstein) and Medicine (Drs Steen and Medsger), University of Pittsburgh School of Medicine.

Footnotes

Accepted for publication April 5, 1988.

Reprint requests to Department of Dermatology and CutaneousSurgery, University of Miami School of Medicine, PO Box 016250(R-250), Miami, FL 33101 (Dr Falanga).

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