Diagnosing and Treating Scleroderma Online
Scleroderma is an autoimmune condition of the connective tissue characterized by skin thickening, spontaneous scarring, blood vessel disease, and varying degrees of inflammation, associated with an overactive immune system. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. Scleroderma is characterized by the formation of scar tissue (fibrosis) in the skin, which leads to thickness and firmness of involved skin, or in internal organs such as the kidney, and is classified as localized or widespread (systemic scleroderma with a tendency to affect internal organs). Systemic scleroderma is further divided into limited and diffuse based upon the extent of skin involvement. Scleroderma is not contagious, infectious, cancerous, or malignant.
Like any chronic disease, scleroderma can be serious. Symptoms can vary greatly for each person, and the effects can range from very mild to life threatening. The seriousness will depend on the parts of the body that are affected, and the extent to which they are affected. A mild case can become more serious if not properly treated. Prompt and proper diagnosis and treatment by qualified physicians may minimize the symptoms and lessen the chance for irreversible damage.
You and your online doctor can help determine the severity of your scleroderma, what type of treatment you need, or if a referral to a specialist is needed.
During a video consult on Amwell, one of our board-certified doctors will ask you a series of targeted questions to determine the severity of your scleroderma. With our video capabilities, you can bring your phone, tablet or desktop with video close to the part(s) of your body showing the signs of scleroderma, so your provider can get a clear view. Your diagnosis will be based on the physical exam, duration, severity of symptoms, and your medical history.
Our platform also has an image upload feature that is extremely helpful for both providers and patients. If your scleroderma has external indicators, this feature can be very useful to determine how it has progressed. With this feature, our physicians can get a precise, detailed look at the possible signs of scleroderma – such as joint swelling and finger ulcers – before the visit even begins. If you have a picture from when the scleroderma signs began, it is helpful for our providers to see the comparison. For best results we recommend pictures be taken in bright, natural light, close to the affected area and from a few different angles. If you can give a size perspective – for example, placing a dime near the ulcer believed to be a sign of scleroderma – this can be extremely helpful, too.
Once a diagnosis has been made, your doctor will go over the risks and benefits of the various treatment plans. Treatment for scleroderma is different depending on the severity from hand-warming, lotions and an aspirin regimen for mild cases, to aggressive blood pressure treatments including medication – such as ACE inhibitors such as Lisinopril – for more severe cases.
Options for treatment of Scleroderma may include:
- ACE Inhibitors: Blood pressure medications, particularly the angiotensin converting enzyme (ACE) inhibitor class of drugs, such as lisinopril, are frequently used to control blood pressure and prevent kidney failure
- Colchicine: Some research indicates that Colchicine can be helpful in decreasing the inflammation and tenderness that periodically accompanies hardening of the skin
- Lotions: Skin itching can be relieved with lotions (emollients) such as Eucerin, Lubriderm, and Curel
- Reduce Stomach Acid: Esophagus irritation and heartburn can be relieved with omeprazole (Prilosec), esomeprazole (Nexium), or lansoprazole (Prevacid). Antacids can also be helpful. Elevating the head of the bed can reduce the back flow of acid into the esophagus that causes inflammation and heartburn. Avoiding caffeine and cigarette smoking also helps
- Serotonin reuptake inhibitors: Serotonin reuptake inhibitors, such as fluoxetine (Prozac), can sometimes improve the circulation of affected digits. Drugs that constrict blood vessels, such as pseudoephedrine (Sudafed decongestant), should be avoided
- Immune System Suppressants: Prescription medication is used to suppress overly active immune systems that seem to be spontaneously causing the disease in organs. Medications used for this purpose include penicillamine, azathioprine (Imuran, Azasan), and methotrexate (Rheumatrex, Trexall). Serious inflammation of the lungs (alveolitis) can require immune suppression with cyclophosphamide (Cytoxan) along with prednisone (Deltasone, Liquid Pred)