Scleroderma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

Skin

• Scleroderma affects the skin, and in more serious cases it can affect the blood vessels and internal organs. The most evident symptom is the hardening of the skin and associated scarring. Typically, the skin appears reddish or scaly. Blood vessels may also be more visible. Where large areas are affected, fat and muscle wastage will weaken limbs and affect appearance.

• The seriousness of the disease varies hugely between cases. The two most important factors to consider are the level of internal involvement (beneath the skin) and the total area covered by the disease. For example, there have been cases where the patient has no more than one or two lesions, perhaps covering a few inches. Less serious cases tend not to involve the internal bodily functions.

• There is discoloration of the hands and feet in response to cold. Most patients (over 80%) have Raynaud's phenomenon, a vascular symptom that can affect the fingers and toes.

• Systemic scleroderma and Raynaud's phenomenon can cause painful ulcers on the fingers or toes which are known as digital ulcers.

• Calcinosis is also common in systemic scleroderma, and is often seen near the elbows, knees or other joints.

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
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  Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
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  Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
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  Skin: Scleroderma; shoulders & back
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  Skin: Scleroderma in crest syndrome; calcinosis at elbow
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  Hands: Scleroderma,
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  Hand: Scleroderma, finger, posterior nail fold
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  Skin: Scleroderma, chest, salt and pepper pigmentation
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  Leg: Morphea, circumscribed scleroderma; age 19
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  Face: Morphea, circumscribed scleroderma
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  Clinical appearance of acrosclerotic piece-meal necrosis of the thumb in a patient with systemic sclerosis.
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  Left arm of Scleroderma patient, showing skin lesions
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  Morphea