In addition to the medical history and the skin symptoms, among other things, the laboratory findings of blood and tissue are important. There is an advantage in distinguishing between progressive systemic scleroderma and circumscribed scleroderma.
Manifestations of scleroderma
- In progressive systemic scleroderma there are certain proteins of the defense (antinuclear antibodies) in the blood, which serve not only to confirm the diagnosis, but also to the division of the forms and thus the prognosis. Also, the erythrocyte sedimentation rate (ESR) as a nonspecific sign of inflammation is usually increased. Special studies such as capillary microscopy, which assesses the small vessels on the nail bed, pressure measurements in the esophagus, cardiac ultrasound, and pulmonary function tests can provide information on organ involvement and stage.
- The localized scleroderma is detected by means of a skin tissue sample; in addition, sonography, temperature and flow measurement methods (thermography, laser Doppler flowmetry) as well as MRI examinations of the skull are used, especially for monitoring the course.
Treatment of scleroderma
Because the cause is unclear, only the symptoms can be treated. The aim is to prevent or slow the progression of the disease and to relieve the symptoms. In the progressive form, besides the treatment with drugs such as corticosteroids, immunosuppressants, vasodilators, antihypertensive agents and analgesics, the physical therapy has a high priority. These include, for example: physiotherapy, lymph drainage, connective tissue massage, carbonic acid baths, electrotherapy and heat treatments.
In testing are substances such as interferon, which inhibit the formation of connective tissue; Good experiences have also been made with infusion therapy with iloprost, an active ingredient that protects certain cells. In the local form of radiation (phototherapy) are used, in addition, here also corticosteroids and physical therapy are used.
In trials are substances such as tacrolimus, a locally used inhibitor of calcineurin (an enzyme that plays a role in the immune system), good experience has also been made in certain forms with methotrexate, an antagonist of folic acid, which is often used in severe rheumatism.
In some cases, surgical interventions are inevitable, for example, to fill skin defects or to remove stiffening. Even those affected can do something: A careful skin care with oily ointments, avoiding cold and moisture, consistently abstaining from cigarettes, the regular use of eye ointments and regular exercise exercises, for example in the form of knitting, painting or playing an instrument relieve the discomfort.
Peppermint candy or chewing gum and frequent small meals improve the dry mouth and the dysphagia. It is recommended to spend the annual holiday in the cold winter months in southern countries.
Course and prognosis of scleroderma
The prognosis depends strongly on the form and the pattern of infestation. The circumscribed scleroderma shows in many cases after one and a half to two years a spontaneous stoppage. In the progressive form, the earlier and the more organs involved, the worse the performance restriction and the worse the life expectancy.