Do you have the Groove Sign?

[pattismith]

Finding the groove: The groove sign in scleroderma and related disorders​

A 45-year-old woman presented to our outpatient clinic complaining about positional skin lesions in her lower limbs. Her past medical history was significant for CREST syndrome (CREST: calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) with skin thickening limited to areas distal to the elbows and knees, severe Raynaud’s phenomenon, calcinosis, sclerodactyly and positive anti-centromere antibodies. Although the calves were unremarkable when examined in a recumbent position (Panel A), leg raising elicited distinct longitudinal venous furrowing consistent with a ‘groove sign’ (Panel B and Video (available as supplementary material)). Laboratory and immunologic analysis showed no evidence of disease activity. Cutaneous biopsy documented an unspecific lymphocytic infiltrate, with no presence of eosinophilic cells.

The groove sign presents as skin indentations that follow the pathway of superficial veins. It can be induced by maneuvers that increase venous return, such as leg raising. This sign is probably due to a relative split of skin layers secondary to a fibrotic process between dermis and epidermis. Despite being primarily associated with eosinophilic fasciitis,1 it can be observed in other diseases of sclerodermal-spectrum disorders.

pictures and video in the original article here:

https://journals.sagepub.com/doi/full/10.1177/1358863X16686411

 

[pattismith]

here my leg and arm, with a small venous indentation

 

[sb4]

Would I be right in thinking you need to be pretty lean to be able to see this indentation?

 

[SlamDancin]

I’m very lean and I have some of these indentations . Lots of skin manifestations actually. Redness, random red lines, small cuts, skin that turns white to the touch and takes a little while for blood to return. But like sb4 said the leanness may be part of the reason it’s so visible for me.

 

[pattismith]

thinking about the groove signs: it's commonly associated with fasciitis (eosininophilic fasciitis is considered a rare disease) and "peau d'orange " (thickening of the skin) is another feature of fasciitis.
I looked at similarities with women commonly experiencing thigh/peau d'orange and found that a doctor already made the link:

"The next thing to remember is that there are only two layers of fat in the body: a superficial layer and a deep layer. These two layers are separated by connective tissue, known as fascia. The fat in both layers resides in compartments, much as you would see eggs in an egg crate. These compartments are separated by fibrous bands called trabeculae. They run vertically from the fascia of the deep muscle layer to the fascia under the dermis. 2, 3, 4 It is the destruction of these collagen bands and the release of the fat globules that are the cause of the appearance of cellulite. It has nothing to do with water-retention, poor circulation, accumulated lymphatic fluid or the ubiquitous scapegoat—toxins."
...
In the late phase of the cycle, when estrogen and progesterone drop, the MMPs rise, and at the same time, a cytokine known as IL-1a becomes the major stimulant for the production of MMPs.
...
Anterior cruciate ligament disease, temporal mandibular joint (TMJ) disease, bladder relaxation, stretch marks, and perhaps even diseases such as lupus erythematosus and scleroderma may be related in some way to this process.

https://www.skininc.com/science/physiology/article/21881080/cellulite-revisited

Would I be right in thinking you need to be pretty lean to be able to see this indentation?

yes you may be right, I suppose that veins must be easy to see in order to make this testing.

In some people with more hidden veins it won't be easy to see .

 

[sb4]

The link to MMPs is very interesting. So those groves on your skin are basically further evidence you have poor collagen and a connective tissue disorder, most likely stemming from some sort of immune dysregulation?

 

[pattismith]

The link to MMPs is very interesting. So those groves on your skin are basically further evidence you have poor collagen and a connective tissue disorder, most likely stemming from some sort of immune dysregulation?

yes, probably a collagen disorder, especially type 1 collagen disorder if I follow Dr Pugliese.

This article about the groove sign seems to point in the same direction:

"The groove sign presents as skin indentations that follow the pathway of superficial veins. It can be induced by maneuvers that increase venous return, such as leg raising. This sign is probably due to a relative split of skin layers secondary to a fibrotic process between dermis and epidermis.
Despite being primarily associated with eosinophilic fasciitis,1 it can be observed in other diseases of sclerodermal-spectrum disorders.

https://journals.sagepub.com/doi/full/10.1177/1358863X16686411