Development of point of care thermographic imaging assessments of peripheral perfusion in scleroderma subjects

Scleroderma or Systemic Sclerosis (SSc) is an autoimmune disease characterized by vascular dysfunction (vasculopathy) and fibrosis that affects approximately 300,000 people annually in the United States alone. SSc is a devastating disease with no cure, a median survival of ⁓11 years post diagnosis, and an annual estimated US national hospital cost exceeding $275 million. A common and significant cause of SSc morbidity is skin ulceration. Therefore, accurate assessment of skin involvement, which presents as compromised peripheral blood perfusion due to early onset vasculopathy, is critical for disease diagnosis and for evaluating the efficacy of existing and potential novel therapies. The gold standard for SSc skin evaluations is subjective clinician assessment using the modified Rodnan skin scoring (mRSS). It requires repeated visits over several months to detect fibrotic changes and has proven to be unreliable and insensitive for vasculopathy assessment. Clinical nailfold capillaroscopy assesses microcirculation, but not large vessel perfusion. The combination of micro- and macro- circulation techniques are valuable for assessing SSc-digital ulcer. We report on our efforts implementing IRB approved noninvasive, noncontact, label-free thermographic imaging for skin involvement assessments in SSc subjects during their scheduled routine visits and demonstrate the ability to quantitatively assess peripheral vasculopathy in the exposed hands of a couple test subjects. The results show early promise for point-of-care quantitative assessments of SSc disease progression using an imaging protocol that adds less than five minutes to routine clinical appointments.