Tips for Coping with Scleroderma

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Dermatologist Dr. Joshua Fox Details Treatment Options to Alleviate Scleroderma Symptoms.

Dr. Joshua Fox

Scleroderma is not contagious, infectious, or malignant. But it is usually chronic and sometimes progressive.

Scleroderma means “hard skin” and is generally thought of as a disease that causes hardening of the skin as its primary manifestation. But scleroderma is not a single disease. It is an umbrella term for a group of diseases that involve abnormal growth of the connective tissue that supports many parts of the body. It varies widely from patient to patient, from mild forms in which hard, tight skin is the primary symptoms to life-threatening forms that affect blood vessels and internal organs, such as the heart, lungs, gastro enteral tract, and kidneys. “Scleroderma is not contagious, infectious, or malignant,” says Dr. Joshua Fox, medical director of Advanced Dermatology P.C. “But it is usually chronic and sometimes progressive. And while there is no proven cure, there are treatment options and coping strategies that can be tailored to each individual person to help alleviate symptoms and minimize the effects of the disease.”

Scleroderma is caused by an overproduction of collagen, the fibrous protein that makes up the body’s connective tissue – skin, tendons, and cartilage. It isn’t known precisely what triggers this overproduction but it is thought to be an autoimmune response, in which the immune system turns against the body, in this case stimulating the cells that produce collagen. The excess collagen builds up and causes thickening of connective tissues that interferes with the functioning of the skin and other affected organs.

Estimates put the number of Americans with scleroderma around 300,000. It affects more women than men, particularly women of child-bearing age. While there may be genetic factors that influence the progression of the disease, it is not inherited.

The group of diseases known as scleroderma fall into two main types: Localized scleroderma affects limited areas of the body, generally the skin and related tissues but not internal organs.

It is often mild and sometimes goes away on its own after several years. Systemic scleroderma, a more serious type of the disease, involves the skin and also the tissues beneath the skin, the blood vessels, and major internal organs. These two main types also have sub-categories, some that come on very slowly, others that come on suddenly, making scleroderma a complex disease with multiple, diffuse symptoms that is often challenging to diagnose.

One of the most frequent manifestations of scleroderma is Raynaud’s phenomenon, a condition in which the hands or feet become unusually sensitive to cold and are sometimes permanently damaged by exposure. Other effects cause thick and tight skin on the fingers, calcium deposits in connective tissue under the skin, swelling small blood vessels that causes red spots on the hands and face, and impaired functioning of the esophagus. Severe complications can affect the lungs, gastro enteral tract, kidneys, and heart.

“It isn’t unusual for patients to see multiple specialists – dermatologist, rheumatologist, and internist - for both diagnosis and treatment,” says Dr. Fox. “Patients must take an active role and work closely with their health care team to manage their illness.”

Tips for Managing Scleroderma
There is no drug that can stop the overproduction of collagen. Treatments for scleroderma focus on controlling symptoms and preventing complications. Drugs that suppress the immune system can relieve some symptoms; blood pressure medications that dilate blood vessels can help prevent damage to lungs and kidneys and may alleviate Raynaud’s symptoms; medications that reduce stomach acid can relieve symptoms of acid reflux; pain relievers can make the patient more comfortable.

An exciting new treatment is the use of narrow band UVB light and the use of the Excimer laser. We have found that a use of both of these modalities have reversed the scleroderma and helped with the itching. Many patients who felt tightness have received complete or partial relief of the symptoms with the treatment. It has not only stopped the progress of the condition but reversed it.

“In addition to treatment, in preliminary studies oral biologic medication with antitumor necrosis factors has been shown to be helpful”

  •     Don’t smoke. Smoking constricts blood vessels further and can exacerbate symptoms.
  •     Avoid cold weather when possible and dress warmly, with particular attention to hands and feet.
  •     Avoid very hot water and protect the skin from harsh soaps and cleaners.
  •     Wear dry boots, socks, and gloves
  •     Manage acid reflux by avoiding late-night meals and spicy or fatty foods; take antacids, if approved by your doctor
  •     Eat a healthy diet and get plenty of rest.
  •     Exercise regularly. Develop an exercise plan that includes stretching to keep joints flexible. Swimming can improve muscle strength and mobility.
  •     Maintain daily activities and social contacts
  •     Relaxation techniques can help deal with the stress of chronic illness
  •     See a Dermatologist to monitor and treat the condition, as well.

“The outlook for people with scleroderma has improved dramatically over the last thirty years,” says Dr. Fox. “Our ability to diagnose the disease, manage its symptoms, and prevent complications has come a long way. Most patients lead long, productive, fulfilling lives.”

Joshua L. Fox, M.D., F.A.A.D., Medical Director at Advanced Dermatology PC. He is board certified and specializes in skin cancer, cosmetic surgery, and laser procedures.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation with 13 locations in New York and New Jersey, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.

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