In case of adipocyte dysfunction, as for obesity, circulating adiponectin levels are markedly decreased.46 Dysfunction of the dermal white adipose tissue occurs in SSc, supporting the hypothesis that this leads to low circulating adiponectin levels as seen in SSc.13,47 Previous studies have shown lower circulating levels of adiponectin in patients with SSc compared to controls.45,48 Nevertheless, the small sample sizes in these studies imply a lack of statistical power to support or refute the hypothesis that adiponectin levels are altered in SSc. This evidence concerns the gene ADIPOQ and obesity due to melanocortin 4 receptor deficiency.