practical skin care
TRANSCRIPT
Skin Care in SclerodermaLouise ParkerLead Nurse – Connective Tissue Disease
Background
• Rare
• Autoimmune connective tissue disease
• Collagen overproduction
• Skin tightening
• Internal organ dysfunction
The spectrum
Vascular
Scleroderma
Fibrotic
Raynaud’s phenomenon
Localised
Inflammatory,Vascular & Fibrotic features
Types of Scleroderma
Localised
Morphoealocalised andgeneralised
Linear sclerodermaEn coup de sabre
Systemic
Limited
Diffuse
Scleroderma sine scleroderma
Overlap
The skin
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
Common Problems in scleroderma
• Itchy/dry skin
• Digital ulcers
• Telangiectasia/pigmentation changes/camouflage
• Calcinosis
Dry skin & Itchiness
• The overproduction ofcollagen being laid down inthe skin means that the skin becomes tight, stiff and dry
• This can also mean manypatients will also experienceItchiness
• Immunosuppression?
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
Dry/itchy skin treatments - topical
• Ointments ‘Greasy’Doublebase, Dermol, Diprobase, E45
• Cream Flexitol, Doublebase, Diprobase
• Gel ‘Lighter’Doublebase/Dayleve gel
Other dry/itchy skin treatments
• Specific creams 1% menthol, Balneum, E45 anti-itch
• Antihistamines OTC - Benadryl, PiritonPrescription - Montelukast, Citirizine
• Practical Hand waxing/protection/sunscreen
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
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
Digital ulcer treatments
• Medication review – optimisation of Raynaud’s treatment & pain management
• Vasodilators, oral & intravenous
• Antibiotics
• Expert wound management
• Patient concordance
Digital ulcer treatments
• Antioxidant treatment – Vitamin E and C
• Evening Primrose Oil
• Sildenafil + Iloprost
• Bosentan
• Innovative therapy – from PAH
Telangiectasia
• Dilated superficial blood vessels – face, chest, hands
• A classical outward sign of scleroderma
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
Telangiectasia treatments
• Laser To breakdown the vessels making them look less obvious – dermatology units offer this
• Cosmetic camouflageWax based, waterproof makeup – excellent coverage Charity ‘Changing Faces’ by self referral
• OTC Make upDermablend (Vichy) MAC Cosmetics
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
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!
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
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
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
Any Questions