We studied the effects of ESWT in 8 SSc female patients who received 4 consecutive ESWT sessions (Dermagold– MTS Germany defocused lithotripter device, 10.000 shots/ session applied at the energy level of 0.06 mJ/mmq, frequency of 5 Hz), weekly applied to both hands and to one forearm, keeping the contralateral forearm as control. Circulating vascular endothelial growth factor (VEGF) and von Willebrand factor (vWf) were measured before the treatment, immediately after the first session and at the end of the cycle. Skin involvement was assessed by Rodnan Skin Score (RSS) and by durometry. A visual analogic scale (VAS) was used to evaluate skin wellness.