Diagnosis

Like other unusual and complex autoimmune disorders, limited scleroderma can be difficult to diagnose. Signs and symptoms vary widely and often resemble those of other diseases.

The diagnosis of limited scleroderma is generally made based on your signs and symptoms. During the physical exam, your doctor will look for changes in the texture, color and appearance of your skin. Tests that might aid in the diagnosis include:

  • Lab tests. A sample of your blood can be tested for antibodies that are frequently found in the blood of people with limited scleroderma. But this isn't a definitive test because not everyone with limited scleroderma has these antibodies.
  • Skin biopsy. Sometimes doctors take a small sample of skin that's examined under a microscope in a laboratory. Although biopsies can be helpful, they can't definitively diagnose limited scleroderma.

Your doctor might recommend additional tests to identify lung, heart, kidney or gastrointestinal complications.

Treatment

Limited scleroderma has no known cure. Treatment focuses on relieving signs and symptoms and preventing complications.

Medications

Several types of medications can help ease the signs and symptoms of limited scleroderma, including:

  • Topical antibiotics. If skin ulcers become infected, you might need to apply topical antibiotics and bandage the area. If topical treatment doesn't work, you might need oral or intravenous antibiotics.
  • Antacid drugs. For heartburn, your doctor might suggest drugs that reduce the production of stomach acid.
  • Blood pressure lowering drugs. Medications that open small blood vessels and increase circulation might help relieve Raynaud's symptoms and reduce increased pressure in the arteries between the heart, lungs and kidney.
  • Drugs to suppress the immune system. These types of medications have shown promise in preventing a condition in which excess collagen collects in the tissue between the lungs' air sacs.

Therapy

Stiff, painful joints and skin are common problems in limited scleroderma. Physical or occupational therapy can teach exercises to help you maintain your flexibility and strength.

  • Physical therapy. Stretching exercises are important to help prevent loss of mobility in your finger joints. A physical therapist can also show you facial exercises that can help keep your face and mouth flexible.
  • Occupational therapy. If needed, an occupational therapist can help you learn new ways of performing daily tasks. For example, special toothbrushes and flossing devices can make it easier for you to care for your teeth.

Surgery

Surgery might be necessary for certain problems, such as:

  • Calcium deposits. Large or painful calcium deposits are sometimes surgically removed.
  • Red spots or lines. Laser surgery can reduce the appearance of red spots or lines caused by swollen blood vessels near the surface of the skin.

Lifestyle and home remedies

Keep warm

To reduce Raynaud's symptoms, wear gloves or mittens outdoors when the weather is cool and indoors when you reach into the freezer. To maintain your body's core temperature when it's cool, dress in layers, and wear a hat or scarf, thermal socks, and well-fitting boots or shoes that don't cut off your circulation.

Don't smoke

If you smoke, talk to your doctor about ways to quit. Nicotine constricts your blood vessels, making Raynaud's phenomena worse. Smoking also worsens heartburn.

Exercise regularly

Regular exercise can help you maintain your flexibility and strength. Ask your doctor or physical or occupational therapist what activities are right for you.

Change eating habits

If you have difficulty swallowing, choose soft, moist foods and chew them well. To minimize acid reflux:

  • Eat small, frequent meals
  • Avoid spicy or fatty foods, chocolate, caffeine, and alcohol
  • Don't exercise immediately before or after eating
  • Elevate the head of your bed using blocks
  • Remain upright for two or three hours after a meal and don't eat before bedtime

Protect your skin

Excess collagen destroys sweat and oil glands, leaving your skin stiff and dry. To help soften your skin:

  • Avoid harsh soaps and detergents. Choose cleansing creams or gentle skin cleansers and bath or shower gels with added moisturizers. Wear rubber gloves when doing the dishes or cleaning.
  • Bathe less often. Bathe every other day, and take brief baths and showers, using warm rather than hot water. Be gentle when washing your skin.
  • Moisturize. Apply a rich, oil-based, fragrance-free moisturizer after washing your hands or bathing, while your skin is still damp. Apply moisturizer to you skin throughout the day when your skin feels dry.
  • Use sunscreen. To prevent further damage to your skin, apply sunscreen before you go outside.
  • Use a humidifier. This will increase moisture in your home.

Practice good oral hygiene

Have regular checkups and use special rinses or toothpastes if your dentist recommends them. If your mouth is chronically dry, try drinking more water and sucking on ice chips or hard, sugarless candy. If these measures fail, your dentist might prescribe medication to stimulate the flow of saliva.

Alternative medicine

To help boost blood flow to extremities, you might try biofeedback, a technique that teaches you to control certain body responses. Relaxation exercises or medication also may be helpful.

Coping and support

Because limited scleroderma can affect your appearance and your ability to perform simple tasks, your self-esteem can suffer. Depression and anxiety are common in people with the condition.

Talking with a counselor might help you cope with the changes caused by this disease. Communicating with people who have the same illness, either through online or in-person support groups, also can be helpful.

Preparing for your appointment

Because limited scleroderma can affect different parts of your body, you might need to consult with a variety of doctors, including those who specialize in the treatment of arthritis and other musculoskeletal disorders (rheumatologist), skin disorders (dermatologist) or lung disorders (pulmonologist).

What you can do

To make the most of your appointment, you may want to write a list that includes:

  • A detailed description of your symptoms and when they began
  • Information about medical problems you've had
  • Information about the medical problems of your parents and siblings
  • Medications, vitamins and other dietary supplements you take, including doses
  • Questions to ask the doctor

Take someone with you, if possible, to help you remember the information you're given. For limited scleroderma, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What other possible causes are there?
  • What tests do I need?
  • What treatment do you recommend?
  • Are there self-care steps I can take to help manage my symptoms?
  • How often will you see me for follow-up visits?
  • I have other health conditions. How can I best manage these conditions together?

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • How have your symptoms changed over time?
  • Do you have heartburn?
  • Are you having trouble swallowing?
  • Do your fingers change color when they get cold?
  • Have you lost weight without trying?
  • Have you noticed changes in your bowel habits?
  • Have you been diagnosed with other medical conditions?
May 18, 2017
References
  1. What is scleroderma? Scleroderma Foundation. http://www.scleroderma.org/site/PageNavigator/patients_whatis.html#.WG0T5ZK8zhc. Accessed Jan. 4, 2017.
  2. Scleroderma. American College of Dermatology. http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Scleroderma. Accessed Jan. 4, 2017.
  3. Longo DL, et al., eds. Systemic sclerosis (scleroderma) and related disorders. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.com. Accessed Jan. 4, 2017.
  4. Systemic sclerosis: Diffuse and limited. Scleroderma Foundation. http://www.scleroderma.org/site/Search?query=Systemic+scleroderma,+diffuse+and+limited#.WG0UrpK8zhdv. Accessed Jan. 4, 2017.
  5. Shah AA, et al. My approach to the treatment of scleroderma. Mayo Clinic Proceedings. 2013;88:377.
  6. AskMayoExpert. Scleroderma. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  7. Handout on health: Scleroderma. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Scleroderma/default.asp#3. Accessed Jan. 4, 2017.
  8. Scleroderma. American Academy of Dermatology. https://www.aad.org/public/diseases/painful-skin-joints/scleroderma#tips. Accessed Jan. 5, 2017.
  9. Kidneys. Scleroderma Foundation. http://www.scleroderma.org/site/PageServer?pagename=body_kidney#.WHU6eZK8zhc. Accessed Jan. 10, 2017.