Scleroderma: Diagnosis and Treatment

In addition to the medical history and skin symptoms, laboratory findings of blood and tissue are important, among other things. For this purpose, it is beneficial to distinguish between progressive systemic scleroderma and circumscritic scleroderma.

Expressions of scleroderma.

  • In progressive systemic scleroderma, certain proteins of the defense system (antinuclear antibodies) are found in the blood, which serve not only to confirm the diagnosis but also to classify the forms and thus the prognosis. The erythrocyte sedimentation rate (ESR), a non-specific sign of inflammation, is also usually elevated. With special examinations such as capillary microscopy, in which the small vessels at the nail bed are assessed, pressure measurement in the esophagus, heart ultrasound or lung function testing, statements can be made about organ involvement and stage.
  • Circumscribed scleroderma is detected by skin tissue sampling, in addition, sonography, temperature and flow measurement methods (thermography, laser Doppler flowmetry) and magnetic resonance imaging of the skull are used, especially for follow-up.

Treatment of scleroderma

Since the cause is unclear, only the symptoms can be treated. The goal is to prevent or slow the progression of the disease and relieve symptoms. In the progressive form, physical therapy has a high priority in addition to treatment with medications such as corticosteroids, immunosuppressants, vasodilators, antihypertensive agents, and analgesics. These include, for example: physiotherapy, lymphatic drainage, connective tissue massage, carbonic acid baths, electrotherapy and heat treatments.

Substances such as interferon, which inhibit the formation of new connective tissue, are being tested; good experience has also been made with infusion therapy with iloprost, an active substance that protects certain cells. In the local form, irradiation (phototherapy) is used, and corticosteroids and physical therapy are also used here.

Substances such as tacrolimus, a locally used inhibitor of calcineurin (an enzyme that plays a role in immune defense), are being tested. Good experience has also been made with methotrexate, an antagonist of folic acid that is often used in severe rheumatism, in certain forms.

In some cases, surgical interventions are also unavoidable, for example to fill skin defects or to correct stiffness. The affected person can also do something: careful skin care with oily ointments, avoidance of cold and dampness, consistent abstention from cigarettes, regular application of eye ointments and regular exercise, for example in the form of knitting, painting or playing an instrument, alleviate the symptoms.

Peppermint-containing candies or chewing gum and frequent small meals improve dry mouth and swallowing difficulties. It is advisable to spend annual vacations in southern countries during the cold winter months.

Course and prognosis of scleroderma

The prognosis depends largely on the form and pattern of affection. Circumscribed scleroderma shows spontaneous arrest after one and a half to two years in many cases. In the progressive form, the earlier and the more organs involved, the greater the limitation of performance and the worse the life expectancy.