The hallmark of scleroderma (SSc) is thickened skin (sclero=hard,
derma=skin) which affects the fingers, and often the hands,
forearms, feet, and face. If skin thickening is widespread, it may
extend to the upper arms, thighs, chest, and abdomen. These changes
are due to the excessive
production and uncontrolled laydown of collagen, the substance
normally present in scar tissue. The variety of skin rashes seen in
lupus are due to
inflammation, rather than fibrosis. These include the facial
"butterfly" rash and photosensitivity reaction (rash, hives or
blisters immediately after exposure to sunlight or other sources of
ultraviolet light). The latter is limited to the skin surfaces
exposed. An exception is discoid lupus, which consists of spots or
patches of rash, mostly in sun exposed areas (face, ears,
extremities), which typically cause scarring and skin pigment
changes. The appearance of scleroderma and discoid lupus are
entirely different, and should be easily distinguished from one
another by your physician.
Other features less common in SLE than in SSc include: scarring of
the lower portions of the lung (pulmonary fibrosis); difficulty in
swallowing solid
foods such as bread or meat; and heartburn or indigestion from
stomach acid "refluxing" (coming back up) into the esophagus.
Difficulty swallowing and reflux are due to sluggish and
uncoordinated motion of the muscle layer of the esophagus
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This is scleroderma -- a disease that causes the skin
and
organs to harden as if turning the human body into stone.
(esophageal dysmotility). Scleroderma often leads to finger and hand
deformities as well, due to the combination of skin thickening,
arthritis, tendinitis and tenosynovitis (inflammation and scarring
of
tendons and their lining tissues). These processes ultimately result
in limited movement of the fingers.
Raynaud's
phenomenon -- when fingers turn
blue or white with cold -- occurs in 95 percent of people with
scleroderma and in 40 percent of persons with lupus.
The primary treatment approaches to SSc are quite different from
those for lupus. Therefore, treatment for scleroderma-like problems
in people with lupus should be individualized and directed at the
particular problems present at any given time.
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