Physical examination of skin thickness across 17 body areas rated 0 to 3. Maximum score 51. Used as a primary or secondary outcome in clinical trials of systemic sclerosis (Khanna et al., 2017).
Two severity schemes are used for the total score. Both are shown here because their cut-offs differ. Use the scheme your clinic or study follows.
| Score | Medsger scheme (preliminary; Western reference) | Japanese scheme (MHLW; developed for Japanese patients) |
|---|---|---|
| 0 | Normal | Normal |
| 1 to 9 | Mild (1 to 14) | Mild |
| 10 to 14 | Mild (1 to 14) | Moderate (10 to 19) |
| 15 to 19 | Moderate (15 to 29) | Moderate (10 to 19) |
| 20 to 29 | Moderate (15 to 29) | Severe (20 to 29) |
| 30 to 39 | Severe (30 to 39) | Not assigned at 30; above 30 is very severe |
| 40 and above | End-stage (40 or more) | Above 30: very severe |
The Medsger scheme comes from a preliminary severity scale for systemic sclerosis (Clin Exp Rheumatol). The Japanese scheme comes from the Ministry of Health, Labour and Welfare.
Rodnan and colleagues originally assessed skin thickness at 26 body areas. The modified version scores 17 areas from 0 to 3. It is now the standard skin measure used as a primary or secondary outcome in clinical trials of systemic sclerosis (Khanna et al., 2017).
Clements and colleagues studied inter-rater variability across three independent studies (J Rheumatol, 1993). That variability is why standardized technique and training matter.
Skin thickness, assessed by palpation at 17 body areas. Each area is scored 0 (normal), 1 (mild), 2 (moderate), or 3 (severe), giving a total from 0 to 51.
It is spelled Rodnan. The modified Rodnan skin score is a revision of the earlier Rodnan skin score. Rodman is a common misspelling, so if you searched that way, this is the right page.
Skin scoring is subjective, and examiners can disagree. Clements and colleagues measured interobserver variability across three studies. Consistent technique matters both for trials and for tracking one patient over time.
It is a primary or secondary outcome in most diffuse cutaneous systemic sclerosis trials. Skin thickness is used as a surrogate for disease severity and prognosis.
It tends to accompany more severe internal organ involvement, especially early in the disease. The skin score does not replace organ-specific testing of the lungs, heart, and kidneys.
Sources
Clements PJ, Lachenbruch PA, Seibold JR, et al. Skin thickness score in systemic sclerosis: an assessment of interobserver variability in 3 independent studies. J Rheumatol. 1993;20(11):1892-1896.