Modified Rodnan Skin Score (mRSS)

Clements et al., 1993/1995 — standardised by Khanna et al. (SCTC/WSF), 2017

Purpose
Semi-quantitative measure of skin thickness in systemic sclerosis by palpation; the standard skin outcome in SSc trials and follow-up.
Population
Adults with systemic sclerosis (limited or diffuse). Patient relaxed; upper body seated with arms at the sides, abdomen and legs lying down. Score how the skin feels, not how it looks.
Formula
mRSS = Σ 17 sites × skin thickness 0–3 (face, anterior chest, abdomen, and bilateral fingers, hands, forearms, upper arms, thighs, legs, feet). Range 0–51.
Severity thresholds
No validated severity bands. MCID ≈ 3–5 units (Khanna 2006); progressive skin fibrosis = increase > 5 units and ≥ 25 % in 12 months (EUSTAR, Maurer 2015). Inter-observer variability ≈ 4.6 units.
🔬 Skin thickness — 17 sites
0 — Normal: normal skin thickness; fine wrinkles can be appreciated.
1 — Mild: skin thickness appreciated, but a skin fold is easily made between two fingers.
2 — Moderate: skin thickness appreciated, skin fold made with difficulty, wrinkles cannot be appreciated.
3 — Severe: skin thickness appreciated with inability to make a skin fold between two fingers.
Technique (Khanna 2017): roll the skin between index finger and thumb (two thumbs over bony areas such as the fingers); average the area rather than scoring its worst point. Tethered skin and atrophic (thin) skin are scored 0; oedema has no agreed rule.
Running total 0 / 51
📋 Skin subsets (LeRoy 1988) — reference

The subset is defined by the maximal extent of skin thickening ever reached, not by the current score. The mRSS does not define subsets; the pattern shown above is only a prompt.

Limited cutaneous (lcSSc)
Skin thickening restricted to areas distal to the elbows and knees; the face and neck may be involved. Typical of anti-centromere antibodies; late pulmonary hypertension.
Diffuse cutaneous (dcSSc)
Skin thickening proximal to the elbows and/or knees (upper arms, thighs) and/or on the trunk. Rapid early progression; anti-Scl-70 / anti-RNA polymerase III; higher risk of ILD, renal crisis and cardiac disease.
SSc sine scleroderma
Vascular, serological and visceral features of SSc without skin thickening (mRSS 0).
📚 References
  1. 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):1892–6.
  2. Clements P, Lachenbruch P, Siebold J, et al. Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. J Rheumatol. 1995;22(7):1281–5.
  3. Khanna D, Furst DE, Clements PJ, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. J Scleroderma Relat Disord. 2017;2(1):11–18.
  4. Khanna D, Furst DE, Hays RD, et al. Minimally important difference in diffuse systemic sclerosis: results from the D-penicillamine study. Ann Rheum Dis. 2006;65(10):1325–9.
  5. Maurer B, Graf N, Michel BA, et al. Prediction of worsening of skin fibrosis in patients with diffuse cutaneous systemic sclerosis using the EUSTAR database. Ann Rheum Dis. 2015;74(6):1124–31.
  6. LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15(2):202–5.
  7. Knobler R, Geroldinger-Simić M, Kreuter A, et al. Consensus statement on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: Localized scleroderma, systemic sclerosis and overlap syndromes. J Eur Acad Dermatol Venereol. 2024;38(7):1251–80.
Clinical decision support only. This tool is intended to assist clinical assessment and does not replace professional judgment. Always interpret results in the context of the individual patient.