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Q. Do you think that a skin test is enough to diagnose scleroderma?

Answered by
Dr. Bharat Patodiya
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 12, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

I traveled to a different country to get more in depth testing of multiple health problems. I was diagnosed with the start of scleroderma, because of my gastrointestinal symptoms, idiopathic angioedema, thickened skin, weird blood vessels (tiny red tree-like veins), family history of scleroderma, high CRP and high WBC. The skin test came back showing focal dermal sclerosis. Do you think that is enough to secure a diagnosis? He started me on Methotrexate and Prednisone every second day. I do not appear to have full Raynaud's and my ANA is usually negative. But, I have some intense symptoms and many of which do match the condition. My past medical history includes severe asthma, allergies, angioedema, had episodes of gout  and anaphylaxis. My current medications are Cetirizine 40 mg, Zantac 300 mg, Breo ellipta, Avamys, Singulair, Prednisone and Methotrexate.

Dr. Bharat Patodiya

General Medicine Internal Medicine Medical Oncology
#

Hi,

Welcome to icliniq.com.

  • Yes, in my opinion your case could be suggestive of scleroderma (autoimmune disorder - hardening of skin).
  • However, I want to know the pattern of sclerosis. For scleroderma, it should start from hand and reach main trunk. Also, revert back with details of GI symptoms.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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Hi doctor,

Thank you so much for your answer and that made me feel better about starting such heavy medication. To answer your question, my skin is very thick around my knuckles and tight and shiny on my hands, it is thick and has redness under the surface going up my forearms, then pretty thick with red rashes going up my upper arms. This is where the sample was taken. I wanted to be taken in hand, but he said the hole would be too deep there. Then, the skin on my face (cheeks) is thick and a bit shiny. I often get red cheeks like they are on fire. My front and back are good, but then it starts again on my thighs and that is where the little red veiny trees are. My shins are thick, very dry and sometimes itchy. Finally, my feet have very thick skin. My heels are so thick and there are deep cracks in them. Does that sound in line? I am worried that my rheumatologist will be hung up on the fact my ANA was negative and then I will be back to square one if he does not agree. So, I just wanted to see all the recent findings looks like to an objective rheumatology issue.

Dr. Bharat Patodiya

General Medicine Internal Medicine Medical Oncology
#

Hello,

Welcome back to icliniq.com.

I went through your details and it is also indicating to scleroderma.

  • I will add to my side that you should get complete scleroderma workup. This may include HRCT chest, barium swallow, 2D echo, 24 hour urine protein, liver function test and renal function test.
  • Scleroderma is a systemic disorder and ANA is often negative. Another system may be involved and it is possible that your breathing and GI complaints are also a part of scleroderma.
  • Regarding treatment, you should avoid cold as you have Raynaud's. Also, I suggest adding calcium channel blocker like Nifedipine and Aspirin. Consult your specialist doctor, discuss with him or her and get the treatment with consent.
  • Spontaneous regression is seen and documented in the literature, so keep your spirit up. Your rheumatologist will understand and will be able to help you. Also, make sure of your Methotrexate dosage.

For further information consult an internal medicine physician online.---->https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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Thank you doctor,

You seem like a very knowledgeable and caring doctor. I am having a hard time lately. I feel like maybe I can finally accept this as my word now that I heard it from a rheumatologist’s perspective. Because of my bad asthma, my doctor ordered a high resolution CT scan to check fibrosis. He also ordered an echocardiogram because I get a lot of chest pain. I was diagnosed with costochondritis and I believe that goes along with scleroderma and autoimmune disease. I have a lot of trouble with cardio exercise, plus I have had abnormal EKGs before and Holter monitor that came back really tachycardiac. I guess the echocardiogram was normal. I had a 24 hour urine done a few months ago and I did not hear back, so, I guess it was normal. My liver is good too. I have frequent heartburn even though I take 300 mg of Zantec daily, bloating, some random sharp stomach pains, constipation and hemorrhoids. I also always have a very hard perennial area as a rock, feels tight and uncomfortable a lot. I am not sure if that can occur with scleroderma. Also, I have vaginal swelling too. My chest in the back and ribs are always stiff. Rheumatologist in my town previously thought that I had psoriatic arthritis and arthritis in the ribs, because of high uric acid, inflammation in joints and nail pitting. But, he did not do many tests.

Here, my doctor did a lot of tests, I hope something gives me insight about my stiff ribs and chest. I call it as an elastic band as it feels like there is a tight band around my upper back on the sides. My husband cannot even touch my ribs or the back part of my chest or upper back as it is so tender. I also cough up a lot of thick mucus. Does the focal dermal sclerosis strongly indicate scleroderma in rheumatology? Thank you so much for the help and advice. I am a pretty happy person, I have a lot of support, so I rarely get depressed. But, I get frustrated with all the unknowns and the constant symptoms. Sometimes, it is hard to communicate with doctors. Thanks for the tip about the dermatologist, I will request it from my rheumatologist when I get home. I also visit an allergy specialist once in a few months.

I am scared about the Methotrexate. I used to be on Prednisone almost all the time. I am only taking three pills a week. My muscles in my forearm get very hard like a rock, feel very tight and uncomfortable. Can that be a symptom of scleroderma? I attached some photos, the first shows the thick skin on the back of my hand and the other shows my hands and feet when it is colder in the room temperature (not freezing), I cannot really tell if I have Raynaud's, but my feet go cold and white and three pairs of socks cannot warm them. There is one photo of how purplish my toes and the nails turn when they start to warm, I do not know whether that is Raynaud's. I am very grateful for your time. Thank you.

Dr. Bharat Patodiya

General Medicine Internal Medicine Medical Oncology
#

Hi,

Welcome back to icliniq.com.

  • Regarding your breathless, please let me know the result of HRCT. I will also suggest pulmonary function tests.
  • Yes, the costochondritis could be due to an autoimmune disorder.
  • Please collect 24 hour urine creatine as it is important.
  • Your heartburn and other GI complaint is due to systemic involvement of the GI. You should start prokinetics along with antacids. I usually prefer Levosulpiride and Domstal (Domperidone and Cinnarizine), You are taking Zantac (Ranitidine), while more powerful and effective is Pantoprazole or a similar drug. You should take small frequent meal.
  • Scleroderma usually does not involve perineal area. So, get it examined by a dermatologist. It could be something else.
  • Your biopsy is suggestive of fibrosis, but other complaint  make it systemic case.
  • Methotrexate is better than high dose steroids. I think you are taking 7.5 mg per week. Just keep your creatine under check.
  • Your skin and nail changes are classical and should start Nifedipine. This will relieve your chill feeling and improve blood circulation to the hand and toes.
  • I tried to use acupuncture in one of the severe systemic case a few years back, but the patient defaulted so will not commit to any benefit. However, according to traditional Chinese medicine blue color attract cold energy, so to avoid in symptoms where cold worsen these. It is just a food for thought and not an evidence based statement.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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