Irish Raynaud's & Scleroderma Society

Skin Care in Scleroderma

Moisturising Creams

Special steroid creams will be prescribed for children with Localised Scleroderma, but all sufferers need to make regular applications of unperfumed moisturising cream to afflicted skin areas, protect the skin from trauma, prevent digital ulcers from infecting, and do regular stretching exercises, even if uncomfortable, to prevent the skin tightening up around joints.

Emulsifying Ointment BP

This is a stiff, white, odourless ointment that can be rubbed on to the hands or body instead of soap before washing or showering.  Rubbed between the hands under a running tap, it makes a good emollient bath.  Great care should be taken using a shower or bath that may be slippy from use of moisturising ointments!

Aqueous Cream BP

This is lighter and less greasy than the ointment, but very effective.  It can be used to moisturise hands, face and body daily, as often as needed.

Eurax Cream

An anti-itching cream available over the counter, useful as an alternative to witch hazel and anti-histamine pills to control the itch of dry skin.

Diprobase Cream

This useful hand cream comes in a handy dispenser for placing next to the sink.

The Skin in Scleroderma

Since scleroderma patients almost invariably have Raynaud’s, they will have the problems of dry skin, damage due to lack of blood and oxygen, skin that is prone to cracks and cuts, and is also prone to infection.  They will also have dry, irritated skin elsewhere on the body.  The skin becomes thickened, tough and inflexible in patches on various parts of the body, usually following its initial appearance on the hands as swollen, shiny skin.

Calcinosis

Some sufferers get calcinosis, in which small lumps of calcium push up through the skin forming ulcers that are slow to heal and readily become infected.

Protecting your skin

Normal skin contains a high percentage of moisture that is prevented from drying out by a film of oil.  Dry skin results when this protective oil barrier is lacking due to illness, chemicals or housework with soap or detergents.

Water

Rubber gloves protect the hands and wearing thin cotton gloves inside them prevents the skin sweating uncomfortably.  Using barriers like Vaseline on your hands inside gloves also helps.  Use cream after washing.

Cold

Protection from the cold is essential, and themal gloves, socks and boots are available that will help prevent both the drying effects of weather and Raynaud’s attacks.  Heating aids are invaluable in cold weather, and exercise improves blood supply to the skin.

Sun

For protection from the sun, a sunscreen with UVA as well as UVB rating is best, and light clothing is even better.  The sun is most dangerous between 10 a.m. and 3 p.m., and its rays are intensified next to water.

Care of Ulcers

Ulcers are wounds and must have medical treatment.  Dead tissue must be removed, and infection cleared by antibiotics.  Always follow your doctor’s instructions.  Generally, soak the sore in warm water for five minutes, cleaning off dead skin, dry it thoroughly, and apply the antiseptic, antibiotic ointment, and dressing that are recommended by your nurse or GP.  Best results rely on using the kind of dressing specifically recommended for you, as there are now many different types available.

Chilblains

Having chilblains does not necessarily mean that you have Raynaud’s, but this is often the case.  Chilblains are red, itchy swellings that appear in cold weather, usually on the feet.  This inflammation is accompanied by severe itching and a burning sensation.  The skin becomes swollen and very tender to the touch.  It can be difficult to wear shoes or to walk.

Prevention

As for Raynaud’s: keeping covered and keeping warm.  Woolly tights, wrist warmers, and long thermal socks are particularly helpful.  Fleecy or sheepskin shoe liners are excellent for keeping feet an even temperature.  Make sure that no footwear fits too tightly.  A woolly hat pulled well down will prevent chilblains on the ears, which is very painful.

Exercise

A daily routine of gentle exercise will maintain better blood flow, and vitamin B can also help.

Warming

Never warm up cold extremities by putting them on a radiator, in front of the fire, or in very hot water.  Too much heat too quickly can cause damage and considerable pain.  Instead, put your hands or feet into bowls of lukewarm and cold water alternatively, and then dry thoroughly.  Place a hot-water-bottle behind your knees instead of on your feet.

Treatment

Treatment of chilblains is primarily to prevent the skin from breaking and to soothe inflammaton.  Cover with a loose, dry dressing, such as a gauze.  You can apply 1% cortisone cream, camphor, or local anaesthetic if the skin is unbroken.  Other gentle creams will also calm down the irritation.  If the skin is broken, treat with an antibiotic cream and a dressing to prevent infection.

Cosmetic Camouflage

Scleroderma sufferers sometimes get harmless, but very numerous and evident red spots that look like broken blood vessels on the face and neck.  Called telangiectasia, these can be safely and effectively masked by make-up or specialised camouflage cosmetics.  The Society can provide members with the names of camouflage experts in Ireland.  In severe cases, some products can be prescribed by your doctor.