Skin Complications and Treatments

Raynaud’s Phenomenon

Raynaud’s phenomenon is a key indicator of scleroderma. Raynaud’s phenomenon is a condition that results in decreased blood flow to your fingers and toes resulting in color changes caused by spasm and narrowing of blood vessels. Raynaud’s causes fingers, toes, and sometimes the ears, nose, or nipples, to turn white, then blue because small blood vessels close up due to cold or stress, depriving these tissues of blood. During an episode, fingers or toes may feel cold and numb. When blood flow returns to these areas, they turn red and may tingle, throb, or swell.

Raynaud’s phenomenon results in decreased blood flow to your extremities, resulting in color changes caused by spasm and narrowing of blood vessels.

This occurs because of excess collagen that has narrowed the blood vessels and the overreaction of the skin blood vessel to cold temperatures and emotional stress.

Raynaud’s phenomenon is a common condition. Most people with Raynaud’s phenomenon will NOT develop scleroderma. Conversely, almost everyone with scleroderma has Raynaud’s symptoms. Among those with scleroderma, the incidence increases to nearly 90%. For this reason, it is a “red flag” that can help lead to earlier diagnosis and treatment. Over time, patients with severe Raynaud’s who have significantly decreased blood flow to the fingers and toes may experience digital ulcers, ischemia, and even gangrene.

Women are much more likely to develop Raynaud’s than men.

Treatments for Raynaud’s Phenomenon

Mild symptoms can be managed by wearing gloves, earmuffs, and heavy socks, and being prepared for the cold. Additionally, wear protective clothing to maintain an adequate core temperature; this is important to prevent the tendency to divert blood away from the extremities when exposed to cold environments. In more serious cases, medications or medical procedures including surgery may be prescribed.

  • Calcium channel blockers, which relax and open blood vessels
  • Alpha blockers, which reduces the effects of the hormone that causes blood vessels to constrict
  • Vasodilators, which relax blood vessels to keep them open
  • Nerve surgery to interrupt the signals that control the opening and narrowing of blood vessels
  • Injections of local anesthetics or Botox to block the nerves in hands and feet

Things that those with Raynaud’s should avoid include exposure to cold, stress and stressful events, and use of medications that cause blood vessels to constrict. These include some treatments for migraine, menopause, and attention-deficit disorder. Other substances with this effect include caffeine, nicotine, amphetamines, and cocaine.

Skin Ulcers

In people with scleroderma, skin ulcers (sores) most often appear at the tips of fingers and may extend under the nails or to the joints. Ulcers may also occur on the legs or other parts of the body following minor trauma such as a bruise.

Skin ulcers (sores) most often appear at the tips of fingers and may extend under the nails or to the joints.

Those who experience repeated episodes of Raynaud’s phenomenon are at risk for ulcers. In addition, calcium deposits under the skin (calcinosis), or even an injury to a finger, may result in the development of an ulcer. Skin ulcers occur in about 50% of those with limited or diffuse scleroderma; they are more common among males and in those with pulmonary arterial hypertension (PAH) or severe involvement of the esophagus.

Treatments for Skin Ulcers

If ulcers are mild, basic wound care and over-the-counter (OTC) medications may provide relief. Medications such as calcium channel blockers or endothelin receptor blockers may be recommended.

For severe cases including multiple lesions, a more aggressive regimen may be needed. This can include wound care and treatment of infections, anticoagulants and other drugs to improve blood flow, pain medication, and potential surgery or amputation if tissue is too damaged to heal.

Calcinosis

Calcinosis occurs when deposits of calcium phosphate form under the skin. Common locations are on the hands, arms, elbows, knees, and trunk. Severe cases can be very painful and can limit range of motion.

Calcinosis occurs when deposits of calcium phosphate form under the skin.

Most lesions develop slowly and may not cause any symptoms. However in severe cases, the deposits can interfere with joint movement; a lesion may break the surface of the skin with a grainy, yellowish discharge.

Treatments

There are few medications or treatments that are effective against calcinosis. Sometimes antacids can help prevent absorption of phosphate to reduce risk; bisphosphonates help hinder bone turnover and lower calcium and phosphate levels; calcium channel-blockers can diminish the concentration of intracellular calcium. Surgical removal of lesions is also possible, but not all are in areas accessible for surgery, and there is always a risk that lesions will return.

Telangiectasia

Telangiectasias are abnormal blood vessels that usually appear as red dots on the skin. They most commonly occur on hands, fingers, the face, chest, and arms, and in the mouth. Other locations might be over joints, and around the toenails or fingernails.

Telangiectasias are abnormal blood vessels that usually appear as red dots on the skin.

Telangiectasias may appear as red dots or may look like varicose veins, with a spider-web form. They will fade or turn white when the skin is pressed. They are not painful or dangerous themselves but are regarded as part of CREST syndrome, which is a group of symptoms in systemic scleroderma.

Treatment

The appearance of telangiectasias can be reduced with the use of a pulsed dye laser, which targets only the blood vessel and not the surrounding skin. This treatment is often used in dermatology.

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