Background/aim: This study aimed to assess the relationship between skin fibrosis as determined by sonoelastography and the degree of pulmonary involvement as determined by high-resolution computed tomography (HRCT) in patients with diffuse cutaneous systemic sclerosis (dcSSc).Materials and methods: This prospective study included 40 patients with dcSSc. All patients with HRCT scans underwent conventional ultrasonography and sonoelastography to determine skin thickness and degree of fibrosis. The degree of fibrosis was classified according to color-scale sonoelastography. The degree of pulmonary involvement was classified according to HRCT grading groups. The relationship between skin fibrosis and pulmonary involvement was investigated.Results: There was a statistically significant difference between HRCT grading groups according to the sonoelastographic color scale (P < 0.001). Sonoelastographic color-scale groups showed a statistically significant difference in duration of disease (P = 0.013). No significant difference was found between the sonoelastographic color-scale groups in age, sex, or skin thickness.Conclusion: Sonoelastography is a useful and reliable tool for assessing skin involvement in dcSSc. We found a good correlation between the degree of skin fibrosis as determined by sonoelastography and the degree of pulmonary involvement.