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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Rheumatology

Scleroderma mRSS: Modified Rodnan Skin Score Explained

At a Glance

The Modified Rodnan Skin Score (mRSS) is a physical exam that measures skin thickness in 17 areas of the body to track scleroderma. A total score from 0 to 51 helps your rheumatologist monitor disease activity, predict internal organ risks, and check if your medications are working effectively.

In this answer

4 sections

01

The 17 Areas Tested

02

The 0 to 3 Grading Scale

03

What Your Total Score Means

04

Tracking Progress Over Time

When your doctor pinches your skin at every scleroderma appointment, they are performing a test called the Modified Rodnan Skin Score (mRSS). This physical exam measures skin thickness and stiffness across 17 specific areas of your body to calculate a total score between 0 and 51. The mRSS helps your care team track how active your scleroderma is, predict your risk for internal organ involvement, and determine whether your current medications are effectively slowing or reversing the disease.

The 17 Areas Tested

During the exam, the doctor will check 17 specific anatomical sites. They will test both the left and right sides of your:

  • Fingers
  • Hands (the back of the hands)
  • Forearms
  • Upper arms
  • Thighs
  • Lower legs
  • Feet

They will also check three central areas of your body:

The 0 to 3 Grading Scale

In each of these 17 areas, the doctor pinches the skin between their fingers to feel its thickness and mobility. They assign a grade from 0 to 3 for every area:

  • 0 (Normal): The skin feels soft, thin, and can be easily pinched.
  • 1 (Mild): There is mild skin thickening, but the skin can still be pinched easily.
  • 2 (Moderate): The skin is noticeably thick and stiff, and it is difficult to pinch.
  • 3 (Severe): The skin is extremely thick, tight, and “hidebound” (firmly bound down), making it impossible to pinch or lift. [2]

(Note: Can hidebound skin ever soften? Yes. Over time or with effective medication, even grade 3 skin can soften and regress. However, it may not return to completely “normal” grade 0 skin—it often becomes thinner and more fragile as it softens [3][4].)

What Your Total Score Means

By adding up the scores from all 17 areas, your doctor gets your total mRSS, which ranges from 0 to 51 [1].

1. Classifying Your Scleroderma
The distribution of where your skin is thickening helps doctors determine which subtype of scleroderma you have [5][6]:

  • Limited Cutaneous Systemic Sclerosis (lcSSc): Skin thickening is generally limited to the face and the areas below the elbows and knees. Total scores usually remain lower and more stable [1][7].
  • Diffuse Cutaneous Systemic Sclerosis (dcSSc): Skin thickening also involves the upper arms, thighs, chest, or abdomen. Total scores are typically higher and can change more rapidly [1][7].

2. Understanding “Typical” Scores
There is no single “good” or “bad” score, but clinical trials often look at scores between 18 and 25 to identify patients who have highly active, progressive diffuse scleroderma [8][9]. A higher total score generally indicates more extensive skin fibrosis (scarring of the skin) [10][11].

3. Predicting Internal Organ Risk
Your skin score serves as an early warning system. A continuously rising mRSS over a 6- to 12-month period, especially within the first few years of diagnosis, alerts your doctor to a higher risk of developing internal complications [10][3]. Monitoring the score closely allows your team to catch and treat issues early before they become severe. Risks associated with rapid skin thickening include:

  • Interstitial Lung Disease (ILD): Scarring of the lung tissue [11].
  • Pulmonary Arterial Hypertension (PAH): High blood pressure in the arteries of the lungs [12].
  • Scleroderma Renal Crisis (SRC): A sudden, severe increase in blood pressure that can rapidly damage the kidneys [13][14].

Tracking Progress Over Time

In the early stages of the disease, your doctor may perform the mRSS every 3 to 6 months to watch for changes.

If your total score decreases over several months, it suggests that your immune-suppressing or anti-fibrotic medications are working. In the early stages of diffuse scleroderma, improvements in your skin score frequently mirror stabilization in internal organ function [15][10].

Important Note on Score Changes: Because this is a manual test relying on human touch, different doctors might grade your skin slightly differently [16][17]. A minor 1- or 2-point fluctuation between visits is completely normal and does not automatically mean your disease is getting worse. For the most consistent tracking, it is best to have the same rheumatologist perform the mRSS at every visit.

Common questions in this guide

What is the Modified Rodnan Skin Score (mRSS)?
The mRSS is a physical exam where your rheumatologist pinches your skin in 17 different areas of your body to measure thickness and stiffness. It helps track how active your scleroderma is and whether your medications are working.
What is the highest possible mRSS score?
The highest possible total score is 51. Your doctor grades 17 specific areas of your body on a scale of 0 to 3, where 0 represents normal skin and 3 means the skin is extremely thick, tight, and impossible to pinch.
Can hidebound skin in scleroderma ever soften?
Yes, severely tight or hidebound skin can soften over time or with effective medication. While it may not return to completely normal skin and can become thinner or more fragile as it softens, noticeable improvement is possible.
What does a rising mRSS score mean?
A score that rises rapidly over 6 to 12 months can be an early warning sign of a higher risk for internal complications, such as lung scarring or a renal crisis. Closely monitoring your score helps your doctor catch and treat these problems early.
Why might my mRSS score fluctuate between appointments?
Because the mRSS is a manual test that relies on human touch, different doctors might grade your skin slightly differently. A minor one- or two-point change between visits is normal and does not automatically mean your scleroderma is worsening.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What was my total mRSS today, and how does it compare to my score from my last visit?
  2. 2.Based on the specific areas where my skin is thickening, do you classify my scleroderma as limited or diffuse?
  3. 3.Are there specific areas of my body where the skin thickening is progressing more rapidly, and should we focus physical therapy on those joints?
  4. 4.What is our 'target' score, or how much of a decrease are we looking for to know if my current medication regimen is working?
  5. 5.Does my current skin score progression indicate that we should be monitoring my blood pressure more closely at home for signs of renal crisis?

Questions For You

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References

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This page explains the Modified Rodnan Skin Score (mRSS) for educational purposes only. Always consult your rheumatologist to understand your specific score, disease progression, and scleroderma treatment plan.

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