Derma with Dr Ditlotlo (Part 1)
Tight skin around joints results in limited mobility of the affected joints.
Fingers become puffy due to swelling and thickness of the skin and this results in contractures and loss of function.
Calcinosis- Calcium deposits beneath the skin. These may appear as hard painful lumps under the skin, and these may release white/chalky material if they break open.
Blood vessels Related Symptoms
Raynaud’s Phenomenon- This is an exaggerated response to a cold stimulus/emotional stress by blood vessels in the fingers, toes, ears and tip of the nose resulting in colour changes – white, blue, red. Severe Raynaud’s can result in sores/ ulcers on the fingertips.
Telangiectasia- Small dilated blood vessels that occur near the surface of the skin and mucous membranes. This will be seen as tiny red spots on the hands and face.
Erectile dysfunction- This is a major issue in Systemic sclerosis, and it is due to impaired penile blood flow.
Musculoskeletal symptoms
Joint pains, stiffness and reduced range of movement due to overlying skin tightness are common features. Mild muscle weakness is common, and this is usually due to associated muscle inflammation(myositis)
Gastrointestinal/ Digestive symptoms
Scleroderma can affect any part of the digestive system, and symptoms include:
Heartburn and acid reflux due to incompetent lower oesophageal sphincter
Difficulty swallowing (dysphagia) due to oesophageal dysmotility
Loss of appetite, nausea due to delayed emptying of the stomach.
Bleeding from the stomach with resultant Anaemia- due to bleeding prominent dilated blood vessels in the lining of the stomach (telangiectasia)
Bloating, Diarrhoea, Constipationdue to motility problems in the intestines with resultant dilatation and malabsorption and weight loss.
Fecal incontinence- This can be due to Neuropathy (nerve damage) affecting the rectum.
Heart and Lung Related symptoms
Lung Fibrosis- Presentation with Shortness of breath, cough, fatigue). Lung involvement is the leading cause of mortality in systemic sclerosis.
Heart- Presentation with Shortness of breath, fatigue, chest pain, palpitationsdue to pericardial effusion (fluid around heart due to inflammation of the lining of the heart).
Kidney Related symptoms
Scleroderma renal crisis is a kidney complication of scleroderma. It is a serious and potentially fatal condition characterized by abrupt onset of high blood pressure, rapid rise in renal function tests, anaemia, confusion, seizures and pulmonary oedema(fluid in the lungs). It usually occurs in those with Diffuse cutaneous systemic sclerosis.
Continues next week .....