Pitting scars in progressive systemic sclerosis.

The digital pitting scar is a common clinical feature in patients with progressive systemic sclerosis (PSS). Its pathogenesis is unclear, but it may result in small ulcerations. The clinical and histological features of these lesions are poorly understood. Eighty-seven patients with PSS were examined at least once per year. Pitting scars were defined as pinhole-sized digital concave depressions with hyperkeratosis. They were seen in 34 cases (39%) and were located not only on the tips of the fingers, but also on the sides, especially on the radial border of the index and middle finger and the ulnar side of the thumb, where they had a linear arrangement. Additional pitting scars were noticed on the dorsal surface of the proximal interphalangeal and metacarpophalangeal joints. Pitting was closely associated with several signs of PSS, e.g. Raynaud's phenomenon, skin thickening or articular involvement (e.g. stiffness, swelling, pain). There was no relationship between the number of pitting scars and the duration of PSS. Biopsy samples were taken of the lesions on the lateral sides of fingers in 3 patients. Histologically, there was a plug-like hyperkeratosis with parakeratosis, homogenized collagen fibers and slight perivascular mononuclear cell infiltration. Calcification and altered collagen fibers were observed in the deep dermis. Although pitting scars of the fingertips may be different from those of the lateral sides of the fingers, both histologically and pathogenetically, they were similar clinically. The scar locations on the fingertips and finger joints (proximal interphalangeal and metacarpophalangeal) suggest that exogenous trauma, vibration injury and/or cold exposure may play a role in their pathogenesis.