Scleroderma is a group of diseases that causes skin and sometimes internal organs to become hard and tight. In fact, the word scleroderma actually means "hard skin." Scleroderma occurs when the body makes too much collagen, the protein that makes up connective tissues.
Localized scleroderma usually only affects the skin on the hands and face. Systemic scleroderma is more serious and affects connective tissue in many parts of your body, including internal organs. Scleroderma is considered an autoimmune disease, meaning that the immune system mistakenly attacks the body's own tissues. According to the Scleroderma Foundation, about 300,000 people in the United States have the condition. It is more common in women than men.
It isn't always easy to diagnose scleroderma. You may need to see both a rheumatologist (arthritis specialist) and a dermatologist (skin specialist). The doctor will do a physical examination and feel your skin, checking for thickened and hardened areas. The doctor may also press affected tendons and joints. The doctor may also do the following procedures:
- Blood tests -- may find higher levels of antibodies made by the immune system.
- Skin biopsy -- may find skin problems.
- Chest X ray or pulmonary function test -- may find lung damage.
- MRI or CT scan -- often finds early signs of damage to the muscles and internal organs.
Many early scleroderma symptoms are like those of other connective-tissue diseases, such as rheumatoid arthritis, lupus, and polymyositis. When someone has more than one of these diseases, it is called mixed connective-tissue disease.
There is no cure for scleroderma. Medication can treat symptoms and may help prevent complications. Lifestyle and dietary changes can make living with the disease easier.
These simple steps may help improve quality of life:
- Eating small, frequent meals may reduce heartburn or gas.
- Exercise helps keep skin and joints flexible.
- Don't smoke, because nicotine contracts blood vessels, which makes scleroderma worse.
- Avoid exposure to cold and stress, which can affect circulation.
- Use soothing skin creams to reduce pain, swelling, and stiffness.
Localized scleroderma often is treated with moisturizers applied to the skin or corticosteroids. Oral medications such as minocycline (Minocin or Dynacin) may also be used to stop the progression of localized scleroderma if it involves a large area of the body, such as an entire arm or leg.
Systemic scleroderma may be treated with medications that improve circulation, reduce heartburn, preserve kidney function, and control high blood pressure. Some medications a doctor may prescribe for scleroderma include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) -- to relieve joint pain and inflammation
- Medications to promote better circulation -- can help prevent high blood pressure and reduce symptoms of scleroderma. They include:
- Calcium channel blockers
- Angiotensin II receptor blockers
- Angiotensin-converting enzyme (ACE) inhibitors
- Alpha blockers
- Disease-modifying anti-rheumatic drugs (DMARDs) -- slow the progression of the disease. They include:
- Hydroxychloroquinine (Plaquenil)
- Methotrexate (Rheumatrex)
- Sulfasalazine (Azulfidine)
- Immunosuppressants -- suppress an overactive immune system. These drugs can have serious side effects including kidney damage and increased risk of infection. they include:
- Azathioprine (Imuran)
- Cyclophosphamide (Cytoxan)
- Cyclosporine (Neoral)
- Antacids -- to reduce heartburn when there is damage to the esophagus
Surgery and Other Procedures
When symptoms of scleroderma become very severe, doctors may recommend the following procedures:
- Surgery to fix damage to the stomach or intestinal walls
- Amputation of severely diseased and infected fingers or toes
- Kidney, heart, or lung transplants, in rare cases
Nutrition and Dietary Supplements
People with scleroderma may not get enough vitamins and minerals in their diet, especially if there is damage to their gastrointestinal system. Ask your team of health care providers about the best ways toad complementary and alternative therapies into your overall treatment plan. Always tell your doctor about the herbs and supplements you are using or considering using.
These general nutritional tips are good for your overall health, especially if you have a chronic disease:
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
- Avoid refined foods such as white breads, pastas, and especially sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
- Use healthy oils, such as olive oil or vegetable oil.
- Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, and processed foods.
- Avoid caffeine, alcohol, and tobacco.
- Drink 6 - 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, five days a week.
Your doctor may also recommend taking a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
These supplements may help reduce some symptoms:
- Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily. Omega-3 fatty acids help improve circulation, and a few studies suggest they may reduce symptoms of Raynaud's phenomenon and improve tolerance to cold. Cold-water fish, such as salmon or halibut, are good sources. Omega-3 supplements may increase your risk of bleeding. If you take blood-thinning medications such as warfarin (Coumadin) or aspirin, ask your doctor before taking omega-3 supplements.
- Bromelain, standardized, 40 mg three times daily. Although not a specific treatment for scleroderma, bromelain helps reduce pain and inflammation. It is often combined with turmeric. Bromelain may increase the risk of bleeding. If you take blood-thinning medication such as warfarin (Coumadin) or aspirin, ask your doctor before taking bromelain.
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Very few studies have been done using these herbs to treat scleroderma. Ask your doctor before adding any of these herbs to your treatment plan.
- Turmeric (Curcuma longa) standardized extract, 300 mg three times a day. Lab studies show that turmeric reduces inflammation. It may also help relieve pain, although more studies are needed to tell whether it has any specific effect on scleroderma. It is often combined with bromelain. Turmeric may increase the risk of bleeding. If you take blood-thinning medication such as warfarin (Coumadin) or aspirin, ask your doctor before taking turmeric.
- Gotu kola (Centella asiatica) standardized extract, 50 - 250 mg two to three times daily, for blood vessel health and circulation. Some purified extracts of gotu kola seem to reduce symptoms of scleroderma. More research is needed to know whether it really has any benefit. Gotu kola may interact with sedative medications, and may affect the liver. Ask your doctor before taking gotu kola.
A few studies suggest that acupuncture may improve circulation in the hands and fingers, help heal fingertip ulcers, and maybe reduce the formation of fibrous tissue in people with scleroderma. Acupuncture may also relieve pain.
Massage and Physical Therapy
Research suggests that massage may help improve circulation. More research is needed to know whether massage is really an effective therapy for scleroderma.
Biofeedback may help some people with scleroderma better control the temperature in their hands and feet, although studies are mixed. Other mind-body techniques such as counseling, meditation, and emotional freedom technique (EFT) may help.
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