6. What does it do for us?
• Our personal barrier to the outside world
• Packed full of sensors to protect from injury and
exposure to the elements
• Although it is our protection it is also full of bugs!
• Our biggest organ and accounts for around 15%
of our total body weight
7. Common Problems in scleroderma
• Itchy/dry skin
• Digital ulcers
• Telangiectasia/pigmentation changes/camouflage
• Calcinosis
8. Dry skin & Itchiness
• The overproduction of
collagen being laid down in
the skin means that the skin
becomes tight, stiff and dry
• This can also mean many
patients will also experience
Itchiness
• Immunosuppression?
9. Dry/itchy skin
• Emollients - NOT SOAP for washing/bathing
Aveeno, Hydromol, Epaderm, Doublebase
• Soap is drying on the skin due the ingredients used –
various chemicals, detergents and preservatives
• Additives that make soap ‘lather’ can also be drying and
irritate the skin
• No shower gel, liquid hand soap, ‘cream’ bath or shower
creams or alcohol gels if possible
11. Other dry/itchy skin treatments
• Specific creams
1% menthol, Balneum, E45 anti-itch
• Antihistamines
OTC - Benadryl, Piriton
Prescription - Montelukast, Citirizine
• Practical
Hand waxing/protection/sunscreen
12. Digital Ulceration
• Classical outward sign of scleroderma
• Partial or full thickness skin loss often over fingers or
toes but also over pressure points.
• Combination of Raynaud’s and skin changes in
Scleroderma can lead to tissue breakdown resulting in a
digital ulcer.
• Around 40% of scleroderma patients suffer with digital
ulceration
13. Manifestations
• Some patients with persistent ulcers may develop
gangrene
• Infection is common if healing time is prolonged
• Often slow to heal because of poor circulation and
tight skin
• Huge impact on quality of life – pain, activities of
daily living, washing, grooming, preparing food
17. Telangiectasia
• Usually harmless but can affect body image as
they can be difficult to cover
• Troublesome if they bleed internally (‘GAVE’ or
‘watermelon stomach’) as this can cause anaemia
but treatable with laser
• Two main approaches can be helpful
18. Telangiectasia treatments
• Laser
To breakdown the vessels making them look less
obvious – dermatology units offer this
• Cosmetic camouflage
Wax based, waterproof makeup – excellent coverage
Charity ‘Changing Faces’ by self referral
• OTC Make up
Dermablend (Vichy) MAC Cosmetics
19. Calcinosis
• This is either hard lumps of a ‘chalky’ like
substance that works its way out through the
layers of the skin
OR
• Rises to the surface of the skin in a ‘toothpaste’
like consistency which then leaks out from the
wound
• Extremely painful, often leads to infection and can
precede an ulcer
20. Calcinosis
• Often appears over pressure points - fingers,
elbows, knees but also over buttocks and
abdomen
• Can lay down in the skin as large plaques which
can cause functional disability as well as pain and
distress
• Often gets ‘picked at’ by patients!
21. Calcinosis treatments
• Poorly understood pathology so usually treated
conservatively
• Expert wound management
• Antibiotics if infected +/- vasodilators
• Surgery to remove large areas or in places that
affect function/ROM – but can come back
22. Conclusion
• Lots of practical and self help measures can be
useful – change of routine/making
time/consistency
• Local GP and local pharmacists can offer advice
• Referral on to a Dermatologist
• Specialist / larger units will often work with several
departments and other specialists who can help
23. Remember…
• Everyone is different
• Symptoms vary from person to person
• Can occur in different stages in varying degrees of
severity
• What may work for you, may not for someone else