Dermoscopy May Help Predict Systemic Involvement in Systemic Sclerosis: Study
A recent 22-month cross-sectional study published in the Indian Journal of Dermatology in July 2026 highlights dermoscopy as an exciting new prognostic tool for systemic sclerosis (SSc). By evaluating early pigmentary changes—most notably vitiligo-like macules in 70% of patients and salt-and-pepper pigmentation in 61.6%—clinicians can utilize these easily visible skin variations as critical early markers to predict underlying internal organ damage.
SSc is characterized by skin thickening and vascular-related pigmentary changes. Addressing a research gap in Asian populations, investigators at the Government Medical College, Kozhikode, evaluated the clinical and dermoscopic features of these pigmentary abnormalities to determine their association with systemic organ involvement.
Therefore, the 22-month cross-sectional study evaluated 60 systemic sclerosis patients at a tertiary center to analyze specific clinical and dermoscopic pigmentary patterns and their systemic complications. To accurately isolate disease-related pigmentation, researchers excluded patients with overlap syndrome, prolonged hydroxychloroquine use (>1 year), or high-dose cyclophosphamide exposure (3900 mg).
Key Clinical Findings of the Study Includes:
Predominant Pigmentary Patterns: Investigators found that vitiligo-like macules were the most common pigmentary abnormality, manifesting in 70% of patients, closely followed by salt and pepper pigmentation in 61.6% of the cohort.
Dermoscopic Discoveries: Researchers documented that a petaloid pattern was present in 57% of vitiligo-like macules, whereas white homogenous areas with perifollicular pigment retention predominantly characterized 89.2% of salt and pepper lesions.
Vascular Correlations: Authors noted that red structureless areas, denoting underlying vascular changes, were visible on dermoscopy in more than 50% of patients exhibiting salt and pepper, melasma-like, and periorbital pigmentation.
Systemic Ulcerations: Scientists reported that approximately 70% of individuals with vitiligo-like macules, salt and pepper patterns, and localized diffuse hyperpigmentation concurrently suffered from digital ulcers.
Pulmonary Associations: Clinicians observed that interstitial lung disease (ILD) complicated the disease course in 30% of patients presenting with localized diffuse hyperpigmentation, compared to roughly 20% of those displaying vitiligo-like macules or salt and pepper changes.
The results suggest that specialized dermoscopic vascular and scale patterns uniquely correspond to different pigmentary variations, reinforcing the clinical reality that 100% of participants exhibited skin thickening, sclerodactyly, and pigmentary abnormalities upon presentation.
Thus, the study concludes that incorporating dermoscopy into routine evaluation might gently guide healthcare professionals (HCPs) in distinguishing scleroderma-induced hypopigmentation from conditions like true vitiligo, offering an accessible method to track underlying microvascular complications and forecast overall disease trajectory.
The institution-based study is somewhat limited by the possibility that its findings may not entirely reflect the exact incidence of pigmentary disturbances across the general affected population. However, observing the subtle correlation between reduced vascular markings in diffuse hyperpigmentation and more severe pulmonary involvement gently highlights a compelling area where future research could gracefully expand our understanding.
Reference
Shijini N, Khader A, Keerankulangara D, Fathimathusalma O, Amrutha D. Clinical and dermoscopic features of pigmentary changes in scleroderma and its association with systemic involvement - A descriptive study from a tertiary care centre in South India. Indian J Dermatol 2026;71:272-9.
