About Scleroderma

Scleroderma is an autoimmune and rheumatic disease.

 

Scleroderma is an autoimmune disorder—a rheumatic disease that causes inflammation in the skin and other areas of the body. The name scleroderma literally means “hard skin” because the inflammation triggers the body’s own immune system to make too much collagen, leading to the hardening and tightening of the skin and connective tissues (ie: fibrosis). In the most serious cases, there can be complications resulting in damage to the heart, lungs, and digestive system.

Scleroderma is a single disease. It can progress in very variable ways in individual patients. Some are affected early with aggressive changes while others have milder symptoms. The disease might progress quickly or slowly. This makes a concise definition—and diagnosis—difficult.

Who Gets Scleroderma?

Scleroderma is relatively rare. An estimated 300,000 Americans have scleroderma (about 100,000 with systemic scleroderma and 200,000 with localized scleroderma). Anyone can get this disease, but you can’t catch it from other people. However, some groups have a higher risk of developing scleroderma:

  • Sex: Approximately 80% of people with the disease are women, although men and children can also get scleroderma.
  • Age: The disease often manifests between the ages of 30 and 50.
  • Race: Scleroderma can occur in people of all races and ethnic groups, but the disease can sometimes affect African Americans more severely.

Is All Scleroderma the Same?

No, scleroderma is a heterogeneous disease, meaning not everyone has the same experience. The way in which scleroderma progresses and changes over time varies greatly from person to person.

Is there A Cure?

The cause of scleroderma is unknown. Doctors don’t know exactly what causes the abnormal collagen production to begin, but the body’s immune system appears to play a role. The disease is not contagious and it’s uncommon for direct family members of patients to also have it. Therefore it’s thought that scleroderma may be caused by a combination of factors, including immune system problems, genetics, hormone changes, and environmental triggers.

Although there is no known cure for scleroderma, significant progress has been made in managing its symptoms and some of the most serious complications. People with the disease are now living longer, fuller lives.

Still, we do not yet have therapies to halt or reverse the disease process. Patients continue to experience pain and other disabling symptoms, and many patients die.

At the Scleroderma Research Foundation we are devoting every possible resource to solving the mysteries of this complex, difficult disease. A collaborative approach to research is opening doors to new treatments and ultimately, a cure.

Types of Scleroderma

Localized Scleroderma

Localized scleroderma typically affects only the skin, but in rare cases may extend to the underlying muscle. It generally appears in one or both of these patterns:

Morphea »

The skin is usually the only organ involved in localized scleroderma. In extreme cases, the muscle or joint below also has a hardening of the tissues. Because internal organs are not affected in localized scleroderma, it is not life-threatening. Symptoms of localized scleroderma may improve or go away on their own over time. Frequently though, there is permanent damage in the form of scar tissue that is both disfiguring and painful. It can be disabling.

Linear scleroderma »

Linear scleroderma most commonly occurs in childhood. It causes tight, thick bands to appear on the extremities, the back and front of the trunk, the buttocks, or the face. They often appear as a single band in one body area and can be seen mixed with patches of morphea. Linear scleroderma can affect the bones and muscles.

Systemic Scleroderma

Systemic scleroderma (sometimes called systemic sclerosis or SSc) is an autoimmune disease that can involve many body systems: the skin, blood vessels, heart, lungs, kidneys, or other major organs. Systemic scleroderma is divided into two types: Limited scleroderma and Diffuse scleroderma.

Overview »

Systemic scleroderma (both limited and diffuse) is the most dangerous form of the disease and the primary focus of research funded by the Scleroderma Research Foundation.

Systemic scleroderma affects many parts of the body. In both the limited and diffuse types, there is injury to blood vessels, inflammation, and varying amounts of fibrosis. It can affect the skin, blood vessels, muscles, joints, the gastrointestinal tract, kidneys, lungs, and heart.

Systemic scleroderma causes widespread vascular damage. There is loss of circulation that can lead to painful skin ulcers on fingers, toes, and other extremities. Inflammation and swelling cause pain and can be chronic. Loss of flexibility in the hands and severe skin tightening can impair the use of fingers and toes. The skin of the face may also tighten and harden, especially around the mouth. This makes eating, drinking, and care of teeth difficult.

About 90% of systemic sclerosis patients have a primary symptom called Raynaud’s phenomenon. With this condition, the small blood vessels of the hands, and sometimes feet, overreact to cold or stress.

Limited Scleroderma, aka CREST (Limited Systemic Sclerosis) »

The most common type of scleroderma, Limited scleroderma affects about two-thirds of systemic sclerosis patients. It’s sometimes called CREST Syndrome, because of these commonly associated physical characteristics:

Calcinosis—hard, painful calcium deposits in the skin.
Raynaud’s Phenomenon—when the feet and hands turn white, then blue, then red in response to cold or stress.
Esophageal problems—trouble swallowing or acid reflux.
Sclerodactyly—tightening of the skin on the fingers and toes.
Telangiectasias—small red spots due to dilated blood vessels on the face, lips, forearms, or fingers.

Limited (CREST) scleroderma usually progresses more slowly than diffuse scleroderma.

Chronic pain, loss of mobility, and disfigurement are possible. Treating symptoms is very important. The disease can still be life-threatening. It is critical to monitor for organ damage. Serious complications can occur related to the esophagus, other parts of the gastrointestinal tract, and the lungs. 

Diffuse Scleroderma (Diffuse Systemic Sclerosis) »

The onset of symptoms for this subtype can be rapid and severe. Early in the disease, there is usually an inflammatory phase. This progresses to fibrosis— thickening and scarring of affected parts of the body. In most cases, there is extensive skin fibrosis covering the hands, arms, feet, legs, and other parts of the body.

Fibrosis of internal organs is a very dangerous complication of diffuse scleroderma involving the kidneys, lungs, heart, and gastrointestinal tract. (The lungs are the most commonly affected.) Fibrosis in the lungs causes scarring in the part of the lungs where oxygen passes into the blood vessels. This is called interstitial lung disease (ILD). Sometimes ILD can also lead to or exist with pulmonary hypertension.

People with diffuse systemic sclerosis often suffer from fatigue, weight loss, joint swelling, tightening, and pain. Patients with this subtype should seek early diagnosis, symptomatic and disease-modifying treatment, and frequent monitoring.

Sine Sclerosis »

Some patients do not fit the definitions of limited or diffuse systemic sclerosis. Sine (SEEN-ay) sclerosis is a rare condition that affects a small percent of people with systemic scleroderma. Patients with sine scleroderma do not have the typical hard, thick skin that is characteristic of systemic scleroderma, but still experience an abnormal buildup of scar tissue in their internal organs.

Symptoms of Scleroderma

Early symptoms of scleroderma include:

  • Swollen or puffy fingers
  • Numbness and tingling in fingers or toes
  • Joint pain
  • Weight loss
  • Cold sensitivity (Raynaud’s phenomenon)

Other symptoms may be there early or develop later, including:

  • Shortness of breath, dizziness, chest pain, and dry cough
  • General fatigue (tiredness)
  • Stiffness of hands and feet
  • Changes in skin color
  • Difficulty swallowing
  • Skin thickening or tightness
  • Dry mucous membranes
  • Calcium deposits under the skin
  • Unexplained sores (ulcers) on finger or toes

Having one or two of these symptoms does not mean that you might have scleroderma. If you notice a combination of symptoms, and if they don’t get better over time, please see your doctor or a rheumatologist.

Keep in mind that many other conditions have similar symptoms to scleroderma. So your actual chances of developing it are low. However, being informed and asking questions are the best ways to know for sure.

How is Scleroderma Diagnosed?

There is no single test to diagnose scleroderma, so to make a diagnosis a doctor who suspects scleroderma will ask many questions about what you are experiencing and have experienced over time.

They will ask about your symptoms such as:

  • Are you having problems with heartburn or swallowing?
  • Do you have other problems of the digestive tract, such as bloating and constipation, or unexplained weight loss?
  • Are you often tired or achy?
  • Do your hands turn white in response to anxiety or cold temperatures?
  • Do you have a cough that just won’t go away?

A physical exam will look for signs such as:

  • Skin swelling or tightening
  • Glossy skin
  • Skin with color changes
  • Blood vessel changes on the hands, face, and around nail beds
  • Hard lumps in the skin or other areas
  • High blood pressure
  • Crackles in the lungs

If your doctor suspects scleroderma, they may first order a blood test called an antinuclear antibody (ANA). This test checks for autoimmune diseases. If the result is abnormal, you will need a more specific blood test to look for scleroderma-specific autoantibodies. Their presence will confirm a diagnosis. The doctor may also run a blood count test or blood chemistry panel and may do a skin biopsy, or lung, heart, and gastrointestinal tests.

What Are Options for Care?

Patients who are diagnosed with scleroderma are encouraged to receive care at a specialized Treatment Center where many physicians and clinicians of different specialties work together to provide comprehensive care. We’ve assembled a list of United States locations that provide this kind of care.

View Treatment Centers