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

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: Aug 04, 2023

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.



Welcome to Considering your symptoms, scleroderma (an autoimmune disorder characterized by skin hardening) could be a possibility. To assess further, it's essential to determine the pattern of sclerosis, which typically starts from the hands and spreads to the main trunk. Additionally, please provide details about any gastrointestinal symptoms you might be experiencing, as they could also be relevant for evaluation and diagnosis. It's crucial to consult a healthcare provider for a comprehensive assessment and accurate diagnosis.

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.



Welcome back to Considering your symptoms and details, it is prudent to investigate the possibility of scleroderma. A complete scleroderma workup, including HRCT chest, barium swallow, 2D echo, 24-hour urine protein, liver function test, and renal function test, is recommended. Scleroderma is a systemic disorder, and ANA might be negative. It is possible that your breathing and gastrointestinal complaints could be associated with scleroderma. For treatment, it's essential to avoid cold due to Raynaud's phenomenon. Consider adding a calcium channel blocker like Nifedipine and Aspirin. Consult your specialist doctor, discuss your options, and proceed with their consent. Spontaneous regression has been documented in the literature, so keep a positive outlook. Your rheumatologist will understand and provide appropriate assistance. Also, ensure proper management of your Methotrexate dosage.

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.



Welcome back to Regarding your breathlessness, please share the results of your HRCT, and I also recommend undergoing pulmonary function tests. It's possible that costochondritis could be related to an autoimmune disorder. Ensure to collect 24-hour urine creatinine as it holds importance for evaluation. The heartburn and other GI complaints might be due to systemic involvement of the GI. I suggest starting prokinetics along with antacids, like Levosulpiride and Domstal (Domperidone and Cinnarizine) or a more potent option like Pantoprazole. Consider having small, frequent meals. While scleroderma typically does not involve the perineal area, it's best to get it examined by a dermatologist to rule out other possibilities. Your biopsy indicates fibrosis, but considering other symptoms, it appears to be a systemic case. Methotrexate is preferred over high-dose steroids, and it's essential to monitor your creatinine levels. Your skin and nail changes are characteristic, and Nifedipine should help improve blood circulation and alleviate your chill feeling. While acupuncture was tried in a severe systemic case earlier, there's no guarantee of benefit. Keep in mind that avoiding blue color in symptoms worsened by cold is a traditional Chinese medicine concept without evidence-based support.

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