Introduction: Systemic sclerosis (SSc) is a chronic multisystem disease of unknown etiology, characterized by autoimmunity and inflammation, functional and structural abnormalities in small blood vessels and progressive fibrosis of the skin and visceral organs. The degree of skin involvement is an important measure and a predictor of mortality. Despite the simplicity and usefulness of skin scores, it has drawbacks. For this reason, the development of more objective, precise and sensitive measures of skin involvement is needed for use in clinical trials and in clinical practice. Ultrasound has a great potential as an outcome measure that is quantitative, valid, reproducible and responsive.Aim of work: To compare the results of high frequency ultrasound of skin and subcutaneous tissue in SSc patients with healthy control subjects and to correlate between skin affection in the studied patients and different clinical parameters.Patients and methods: 40 patients with SSc and 40 healthy control subjects were included in the study. All patients were subjected to full history taking, clinical examination, including assessment of the skin by modified Rodnan skin score (mRss), relevant laboratory and radiological tests including high frequency skin ultrasonography at five different anatomical sites.Results: the patients with SSc had thicker skin than control subjects. The ultrasound measurements correlated to the mRss as well as the severity score of the disease. The degree of skin thickening tended to diminish with time. Also, SSc patients had thinner subcutaneous fat thickness than control subjects.Conclusion: Ultrasound technique is a reliable noninvasive tool that gives reproducible results for the evaluation of skin and subcutaneous tissue involvement in patients with SSc, adding a separate dimension to the assessment of the severity, extension and evolution of cutaneous disease.