Understanding Scleroderma -- Diagnosis and Treatment
How Do I Know If I Have Scleroderma?
Scleroderma is often difficult to diagnose, since it may look like many other diseases. Changes in skin thickness, the presence of specific antibodies in the blood, or early blood-vessel changes, can be helpful in diagnosing the disease. Your doctor may remove a small tissue sample (biopsy) for analysis to help in the diagnosis of scleroderma.
One useful indicator that doctors use is the nail-fold capillary test. This focuses on one of the earliest identifiable signs of scleroderma: the disappearance of tiny blood vessels in the skin of the hands and feet. The test involves examining skin at the base of the fingernail using a magnifying glass or microscope. While the test alone doesn't confirm scleroderma, when combined with several typical symptoms, it can aid the diagnosis. For a definitive diagnosis, your doctor must carefully analyze many test results, perform a physical exam, and take a complete medical history.
What Is the Treatment for Scleroderma?
There is no cure for scleroderma. Treatment focuses on relieving symptoms and reducing the risk of complications.
Medications for Scleroderma Symptoms
Localized skin changes may be treated with topical agents like moisturizers or corticosteroid medications, which are of very limited benefit.
Vasodilators, medicines that relax and open the blood vessels, may be prescribed to relieve Raynaud's phenomenon, a very common symptom of scleroderma caused by the spasm of blood vessels in the hands and feet. Avoiding exposure to cold also helps reduce this symptom. Drugs called angiotensin-converting enzyme (ACE) inhibitors and other blood pressure medications may be used to control blood pressure and help prevent serious kidney complications.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, and ibuprofen, may ease joint pain. Systemic corticosteroids, such as prednisone, may be used to decrease inflammation.
Indigestion can occur when scleroderma affects the esophagus, stomach, or intestines. It can be treated with drugs that decrease stomach acidity and promote movement of food through the stomach and intestines. Your doctor may suggest antibiotics, a special diet, and medications to improve your ability to digest food.
D-penicillamine was thought to decrease the production of collagen and in the past was thought to delay the progression of the disease, but it is now used infrequently. Drugs that suppress the immune system, like mycophenolate, cyclophosphamide and methotrexate, may be helpful in some people, but again the results are variable and none are approved for treatment of the disease
Physical Therapy for Scleroderma
Stretching and physical therapy may help keep joints from becoming bent or contracted. Raynaud's can be relieved by staying warm and wearing gloves and warm socks.
Rarely, orthopedic surgery of the hands may be necessary to correct severe joint contractures, skin deformities, or scars.
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