Practical Skin Care presentation from Louise Parker, Lead Nurse Connective Tissue Disease. Presented at our evening event 04/06/2015

1. Skin Care in Scleroderma
Louise Parker
Lead Nurse – Connective Tissue Disease

2. Background
• Rare
• Autoimmune connective tissue disease
• Collagen overproduction
• Skin tightening
• Internal organ dysfunction

3. The spectrum
Raynaud’s
phenomenon
Localised
Inflammatory,
Vascular &
Fibrotic features

4. Types of Scleroderma
Localised
Morphoea
localised and
generalised
Linear scleroderma
En coup de sabre
Systemic
Limited
Diffuse
Scleroderma sine
scleroderma
Overlap

5. The skin

6. What does it do for us?
• Our personal barrier to the outside world
• Packed full of sensors to protect from injury and
exposure to the elements
• Although it is our protection it is also full of bugs!
• Our biggest organ and accounts for around 15%
of our total body weight

7. Common Problems in scleroderma
• Itchy/dry skin
• Digital ulcers
• Telangiectasia/pigmentation changes/camouflage
• Calcinosis

8. Dry skin & Itchiness
• The overproduction of
collagen being laid down in
the skin means that the skin
becomes tight, stiff and dry
• This can also mean many
patients will also experience
Itchiness
• Immunosuppression?

9. Dry/itchy skin
• Emollients - NOT SOAP for washing/bathing
Aveeno, Hydromol, Epaderm, Doublebase
• Soap is drying on the skin due the ingredients used –
various chemicals, detergents and preservatives
• Additives that make soap ‘lather’ can also be drying and
irritate the skin
• No shower gel, liquid hand soap, ‘cream’ bath or shower
creams or alcohol gels if possible

10. Dry/itchy skin treatments - topical
• Ointments ‘Greasy’
Doublebase, Dermol, Diprobase, E45
• Cream
Flexitol, Doublebase, Diprobase
• Gel ‘Lighter’
Doublebase/Dayleve gel

11. Other dry/itchy skin treatments
• Specific creams
1% menthol, Balneum, E45 anti-itch
• Antihistamines
OTC - Benadryl, Piriton
Prescription - Montelukast, Citirizine
• Practical
Hand waxing/protection/sunscreen

12. Digital Ulceration
• Classical outward sign of scleroderma
• Partial or full thickness skin loss often over fingers or
toes but also over pressure points.
• Combination of Raynaud’s and skin changes in
Scleroderma can lead to tissue breakdown resulting in a
digital ulcer.
• Around 40% of scleroderma patients suffer with digital
ulceration

13. Manifestations
• Some patients with persistent ulcers may develop
gangrene
• Infection is common if healing time is prolonged
• Often slow to heal because of poor circulation and
tight skin
• Huge impact on quality of life – pain, activities of
daily living, washing, grooming, preparing food

14. Digital ulcer treatments
• Medication review – optimisation of Raynaud’s
treatment & pain management
• Vasodilators, oral & intravenous
• Antibiotics
• Expert wound management
• Patient concordance

15. Digital ulcer treatments
• Antioxidant treatment – Vitamin E and C
• Evening Primrose Oil
• Sildenafil + Iloprost
• Bosentan
• Innovative therapy – from PAH

16. Telangiectasia
• Dilated superficial blood vessels – face, chest,
hands
• A classical outward sign of scleroderma

17. Telangiectasia
• Usually harmless but can affect body image as
they can be difficult to cover
• Troublesome if they bleed internally (‘GAVE’ or
‘watermelon stomach’) as this can cause anaemia
but treatable with laser
• Two main approaches can be helpful

18. Telangiectasia treatments
• Laser
To breakdown the vessels making them look less
obvious – dermatology units offer this
• Cosmetic camouflage
Wax based, waterproof makeup – excellent coverage
Charity ‘Changing Faces’ by self referral
• OTC Make up
Dermablend (Vichy) MAC Cosmetics

19. Calcinosis
• This is either hard lumps of a ‘chalky’ like
substance that works its way out through the
layers of the skin
OR
• Rises to the surface of the skin in a ‘toothpaste’
like consistency which then leaks out from the
wound
• Extremely painful, often leads to infection and can
precede an ulcer

20. Calcinosis
• Often appears over pressure points - fingers,
elbows, knees but also over buttocks and
abdomen
• Can lay down in the skin as large plaques which
can cause functional disability as well as pain and
distress
• Often gets ‘picked at’ by patients!

21. Calcinosis treatments
• Poorly understood pathology so usually treated
conservatively
• Expert wound management
• Antibiotics if infected +/- vasodilators
• Surgery to remove large areas or in places that
affect function/ROM – but can come back

22. Conclusion
• Lots of practical and self help measures can be
useful – change of routine/making
time/consistency
• Local GP and local pharmacists can offer advice
• Referral on to a Dermatologist
• Specialist / larger units will often work with several
departments and other specialists who can help

23. Remember…
• Everyone is different
• Symptoms vary from person to person
• Can occur in different stages in varying degrees of
severity
• What may work for you, may not for someone else

24. Any Questions