Scleroderma: Supporting Skin Health in a Complex Autoimmune Condition

Scleroderma is a chronic autoimmune disorder characterised by excessive collagen production and progressive thickening of the skin. In some cases, it may also affect internal organs and the small blood vessels that supply them. Whilst the condition is uncommon, its impact on the skin can be both physically and emotionally significant.

At its core, scleroderma involves a malfunction of the immune system. Instead of protecting the body, the immune response mistakenly attacks healthy tissues, stimulating the overproduction of collagen. This leads to fibrosis, or hardening, within the skin and sometimes elsewhere in the body. In addition, damage to the small arteries can impair blood flow, contributing to tissue injury.

The precise cause of scleroderma remains unknown. It is believed to arise from a combination of genetic susceptibility and environmental triggers, although no single factor has been definitively identified.

Cutaneous Features of Scleroderma

The skin manifestations of scleroderma are often among the earliest and most visible signs of the condition. These may include:

• Raynaud phenomenon, in which fingers or toes turn white or blue in response to cold or stress
• Progressive stiffness and tightness of the skin, particularly affecting the fingers, hands, forearms and face
• Hair loss in affected areas
• Changes in pigmentation, with patches of skin becoming darker or lighter than surrounding tissue
• Small white deposits of calcium beneath the skin, which may occasionally discharge a chalky substance
• Painful sores or ulcers on the fingertips or toes
• Tight, mask like facial skin with reduced facial expression
• Telangiectasias, which are small, widened blood vessels visible on the face or around the fingernails

For individuals with sensitive or reactive skin, these changes may be accompanied by dryness, discomfort and increased vulnerability to environmental stressors.

A Sensitive and Individualised Approach to Care

Management of scleroderma requires a thoughtful, multidisciplinary approach. Dermatological care focuses on preserving skin integrity, maintaining flexibility and minimising complications such as ulceration or infection.

Treatment may include prescription medications designed to modulate the immune response and reduce inflammation. In some cases, therapies that improve blood flow are used to help manage Raynaud phenomenon and protect vulnerable tissues.

Supportive skin care is equally important. Gentle cleansing, intensive moisturisation and vigilant sun protection help maintain the skin barrier and reduce irritation. Where telangiectasias or pigmentation changes are prominent, carefully selected light based treatments may be considered, depending on individual suitability.

Preventing Complications

Early recognition and consistent management are crucial in preventing long term complications. Regular monitoring allows treatment plans to be adjusted as needed and ensures that both cutaneous and systemic features are appropriately addressed.

Although scleroderma is a complex and chronic condition, advances in understanding and treatment have significantly improved outcomes. With careful medical oversight and personalised care, symptoms can be controlled and quality of life optimised.

Aesthetic and medical dermatology alike begin with supporting the body’s natural processes wherever possible. In the case of scleroderma, this means protecting the skin, preserving function and addressing symptoms with sensitivity and clinical precision.