No cure for scleroderma is known, though treatments exist for some of the symptoms, including drugs that soften the skin and reduce inflammation. Some patients may benefit from exposure to heat. Holistic care of patients comprising patient education tailored to patients' education level is useful in view of the complex nature of the disease symptoms and progress. Topical/symptomatic Topical treatment for the skin changes of scleroderma do not alter the disease course, but may improve pain and ulceration. A range of nonsteroidal anti-inflammatory drugs, such as naproxen, can be used to ease painful symptoms. The benefit from steroids such as prednisone is limited. Episodes of Raynaud's phenomenon sometimes respond to nifedipine or other calcium channel blockers; severe digital ulceration may respond to prostacyclin analogue iloprost, and the dual endothelin-receptor antagonist bosentan may be beneficial for Raynaud's phenomenon. Skin tightness may be treated<unk> ally with methotrexate and ciclosporin. and the skin thickness can be treated with penicillamine. Kidney disease Scleroderma renal crisis (SRC) is a life-threatening complication of<unk>  sclerosis that may be the initial manifestation of the disease. Renal vascular injury (due in part to collagen deposition) leads to renal ischemia, which results in activation of the renin-angiotensin-aldosterone system (RAAS). This raises blood pressure and further damages the renal vasculature, causing a vicious cycle of worsening hypertension and renal dysfunction (eg, elevated creatinine, edema). Hypertensive emergency with end-organ dysfunction (eg, encephalopathy, retinal hemorrhage) is common. Thrombocytopenia and microangiopathic hemolytic anemia can be seen. Urinalysis is usually normal but may show mild proteinuria, as in this patient; casts are unexpected. The mainstay of therapy for SRC includes ACE inhibitors, which reduce RAAS activity and improve renal function and blood pressure. Short-acting ACE inhibitors (typically captopril) are used because they can be rapidly uptitrated. An elevated serum creatinine level is not a contraindication for ACE inhibitors in this population, and slight elevations in creatinine are common during drug initiation. Scleroderma renal crisis, the occurrence of acute kidney injury, and malignant hypertension (very high blood pressure with evidence of organ damage) in people with scleroderma are effectively treated with drugs from the class of the ACE inhibitors. The benefit of ACE inhibitors extends even to those who have to commence dialysis to treat their kidney disease, and may give sufficient benefit to allow the discontinuation of renal replacement therapy. Lung disease Active alveolitis is often treated with pulses of cyclophosphamide, often together with a small dose of steroids. The benefit of this intervention is modest. Pulmonary hypertension may be treated with epoprostenol, treprostinil, bosentan, and possibly aerolized iloprost. Nintedanib was approved for use in the United States Food and Drug Administration on September 6, 2019, to slow the rate of decline in pulmonary function in patients with<unk>  sclerosis-associated interstitial lung disease <unk> c-ILD). Other Some evidence indicates that plasmapheresis (therapeutic plasma exchange) can be used to treat the<unk>  form of scleroderma. In Italy, it is a government-approved treatment option. This is done by replacing blood plasma with a fluid consisting of albumin, and is thought to keep the disease at bay by reducing the circulation of scleroderma autoantibodies.
Systemic scleroderma
Scleroderma
Chilblain lupus erythematosus
Discoid lupus erythematosus
Tumid lupus erythematosus
Mixed connective tissue disease
Lupus erythematosus
Sjögren syndrome