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 distal upper limbs of 16 healthy controls (mean age 62.3 +/- 13.1 yr) and 16 patients 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 the stained lymphatics; (d) diameter of single lymphatic capillaries. Results. At the finger level, lymphatic capillaries were lacking in five patients, while they were present in all controls (P < 0.05). Extension of the 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 backflow 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 differences were found at the forearm level. Conclusion. Lesional skin in patients with systemic sclerosis exhibits evidence of lymphatic microangiopathy.