Lymphatic microangiopathy of the skin in systemic sclerosis

Methods. The cutaneous capillary lymphatic system in patients with systemic sclerosis was investigated using fluorescence microlymphography. The dista l upper limbs of 16 healthy controls (mean age 62.3 +/- 13.1 yr) and 16 pat ients with systemic sclerosis (mean age 58.9 +/- 13.6 yr) were examined and the following parameters were evaluated: (a) single lymphatic capillaries; (b) lymphatic capillary network and cutaneous backflow; (c) extension of t he stained lymphatics; (d) diameter of single lymphatic capillaries. Results. At the finger level, lymphatic capillaries were lacking in five pa tients, while they were present in all controls (P < 0.05). Extension of th e stained lymphatics was increased in 11 patients (8.1 +/- 6.0 mm) compared to the 16 healthy controls (2.0 +/- 1.2 mm) (P < 0.0001). Cutaneous backfl ow was observed in three patients (P < 0.05). At the hand level, lymphatic network extension was significantly different between patients (3.8 +/- 2.4 mm) and controls (1.2 +/- 0.8 mm) (P < 0.01); however, no significant diff erences were found at the forearm level. Conclusion. Lesional skin in patients with systemic sclerosis exhibits evid ence of lymphatic microangiopathy.