Figure 1.

Alternative systems of SSc classification. Currently, clinical classification separates patients on the basis of limited versus diffuse skin involvement. Moinzadeh et al.⁴ suggest a new SSc subset, intermediate to lcSSc and dcSSc, comprising patients with SSc who have features of an overlapping connective tissue disease. In the future, patients might be classified by gene expression patterns or molecular ‘skin signatures’. For example, using microarrays, Milano et al.⁹ classified biopsy-obtained SSc skin samples into five molecular subsets distinct from clinically classified subsets. A combination approach to classification might provide an enhanced personalized medicine approach to treatment. Abbreviations: dcSSc, diffuse cutaneous SSc; lcSSc, limited cutaneous SSc; SSc, systemic sclerosis.