Rodnan skin score

Skin score (see score below) to assess the clinical severity of systemic scleroderma. Here, 17 body areas are assessed by clinical palpation. The examiner assesses skin thickness using a 4-point scale:

• 0 = normal thickness
• 1 = slight skin thickening
• 2 = moderate skin thickening
• 3 = severe skin thickening.

• Face: Evaluation between Arcus zygomaticus and mandible. The forehead is not assessed.
• Fingers: Focus on the skin of the dorsal side of the fingers. The palm of the hand is not judged. Distally of the DIP joints the skin is difficult to assess. If not assessable, only the area between PIP and MCP joints should be assessed.
• Hands: assessment of the back of the hand only (skin between MCP joints and wrist).
• Forearms and upper arms: the flexion side may be included in the assessment. However, the assessment should primarily consider the dorsal side.
• Thorax: Assessment from the manubrium sterni to the xiphoid including the breasts (patient in sitting position).
• Abdomen: Assessment from xiphoid to iliac crest (patient in supine position).
• Thighs and legs: the patient is in the supine position and has hip, knee and ankle joints flexed.
• Feet: only the back of the foot is assessed. The feet should be examined in the supine position with the hip and knee joints flexed.

1. Della Rossa A et al (2001) European multicentre study to define disease activity criteria for systemic sclerosis. I. Clinical and epidemiological features of 290 patients from 19 centres. Ann Rheum Dis 60: 585-591
2. Valentini G et al (2003) European Scleroderma Study Group to define disease activity criteria for systemic sclerosis. IV. Assessment of skin thickening by modified Rodnan skin score. Ann Rheum Dis 62: 904-905