INCREASED COLLAGEN PROPEPTIDES IN THE SKIN OF A SCLEREDEMA PATIENT BUT NO CHANGE IN REEPITHILIALIZATION RATE

Scleredema is a rare disease, affecting the skin connective tissue wit h increased amounts of collagen and glycosaminoglycans. In the present study, the collagen synthesis and re-epithelialisation rate mere meas ured from a 64-year-old male patient, who rapidly developed extensive tightening of the skin, without any underlying disease, The skin was t hickened at several sites when measured with ultrasound, and the histo logy revealed accumulation of glycosaminoglycans and collagen bundles, The collagen synthesis rate was measured from suction blisters induce d on two different sites of the skin before the treatment and three ti mes later up to 6 months after the treatment with a systemic steroid w as started, The aminoterminal propeptide of type I collagen (PINP) was increased manifold in the affected skin when compared with the contro ls, indicating active collagen deposition in vivo, Systemic steroid me dication with high doses (over 20 mg/d) decreased both the type I and the type III collagen propeptide levels, The time schedule of the decr eases in the propeptides in the thickened, affected skin and in the cl inically normal-looking skin varied, and especially in the thickened s kin in the abdomen the decrease in PINP was noted only after 3 months of prednisolone therapy, When the prednisolone dose was only 10 mg dai ly, the propeptides mere again up-regulated, perhaps reflecting the na tural course of the disease. The re-epithelialisation rates at two dif ferent sites of the patient were similar to those in the controls, sug gesting that even massive fibrosis with active deposition of collagen does not alter the basal rate of re-epithelialisation in the skin. In conclusion, collagen synthesis is markedly elevated in scleredema, lea ding to fibrosis of the skin, A recently developed method utilizing as says of collagen propeptides from suction blister fluid allows monitor ing of the collagen synthesis and detection of changes in the collagen synthesis during the treatment of fibrotic disorders.