Background Currently, assessment of dermal thickness in systemic sclerosis (SSc) is performed by palpation and assessment using the modified Rodnan skin score (mRSS). Objective To verify whether high frequency ultrasound (US) may be a reliable and a reproducible method to measure digital dermal thickness. Methods In 70 patients with SSc, skin thickness was evaluated with US by 2 observers at 2 different sites on the second digit of the dominant limb to determine the interobserver variability. Patients and controls were examined twice by the first observer for intraobserver variability. Patients were divided into three subgroups according to the phase of the disease (oedematous, fibrotic or atrophic). Results At both examined areas, US showed a significant dermal thickening (pConclusions US is a reliable tool giving reproducible results, and is able to detect digital dermal thickening in SSc.