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EditorialEditorial

More Than Skin Deep: Moving From a Skin-Based Phenotypic Model to Molecular Classification of Systemic Sclerosis

Isaac K.S. Ng, Dylan Michael Chong, Ashita Ashish Sule and Julian W.W. Lim
The Journal of Rheumatology August 2026, jrheum.2026-0527; DOI: https://doi.org/10.3899/jrheum.2026-0527
Isaac K.S. Ng
I.K.S. Ng, MMed, Division of Rheumatology and Allergy, Department of Medicine, National University Hospital, and Yong Loo Lin School of Medicine, National University of Singapore.
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Dylan Michael Chong
D.M. Chong, medical student, Yong Loo Lin School of Medicine, National University of Singapore.
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Ashita Ashish Sule
A.A. Sule, MBBS, Division of Rheumatology and Allergy, Department of Medicine, National University Hospital, Singapore, Singapore.
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Julian W.W. Lim
J.W.W. Lim, MMed, Division of Rheumatology and Allergy, Department of Medicine, National University Hospital, and Yong Loo Lin School of Medicine, National University of Singapore.
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Abstract

Systemic sclerosis (SSc) is a multisystemic connective tissue disease, characterized by vasculopathy and fibrosis of the skin and visceral organs. It is conventionally classified according to the extent of skin fibrosis into limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) forms, based on the seminal article of LeRoy et al in 1988.1 According to this classification, lcSSc is characterized by limited skin thickening not extending beyond the elbows and knees, and an association with CREST (calcinosis, Raynaud phenomenon [RP], esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome and pulmonary arterial hypertension (PAH), whereas dcSSc is characterized by proximal and truncal skin thickening, which is rapidly progressive, and greater association with interstitial lung disease (ILD) and scleroderma renal crisis (SRC).1

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The Journal of Rheumatology: 53 (8)
The Journal of Rheumatology
Vol. 53, Issue 8
1 Aug 2026
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More Than Skin Deep: Moving From a Skin-Based Phenotypic Model to Molecular Classification of Systemic Sclerosis
Isaac K.S. Ng, Dylan Michael Chong, Ashita Ashish Sule, Julian W.W. Lim
The Journal of Rheumatology Aug 2026, jrheum.2026-0527; DOI: 10.3899/jrheum.2026-0527

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More Than Skin Deep: Moving From a Skin-Based Phenotypic Model to Molecular Classification of Systemic Sclerosis
Isaac K.S. Ng, Dylan Michael Chong, Ashita Ashish Sule, Julian W.W. Lim
The Journal of Rheumatology Aug 2026, jrheum.2026-0527; DOI: 10.3899/jrheum.2026-0527
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