Scleroderma is a health condition that involves thickening of the skin and may also affect internal organs. It can be difficult to diagnose due to the similarity with other health conditions that have similar characteristic and requires differentiation from these.

Medical and Family History

Upon initial presentation, a consultation with the patient is necessary to establish the previous medical history, indicative symptoms and family history of the disease or other conditions.

This is important to understand the medical history of the individual to establish the risk that scleroderma may be involved. In particular, past treatments of radiotherapy can increase the risk of the condition. Additionally, there are some environmental triggers that may lead to the initiation of the symptoms, such as exposure to silicon, radiation and some solvents.  

Although there are currently no specific genes that have been identified to play a causative role in the development of scleroderma, there appears to be a genetic link because the condition tends to run in families. For this reason, individuals with suspected scleroderma should be asked about any other family members that may have experienced similar symptoms.

Presenting Signs and Symptoms

The skin is the most common area of the body to be affected by scleroderma and is involved in all forms of the disease. Indicative signs of the condition include:

• Skin Hardening
• Skin tightness
• Swelling or puffiness
• Sclerodactyly (skin induration)
• Hyperpigmentation or hypopigmentation changes of the skin
• Itching
• Raynaud’s phenomenon
• Nail-fold capillary changes

In some cases, the involvement of other organs in the body may result in symptoms specific to affected organs. This is known as systemic sclerosis and can lead to the following symptoms, according to which organs are involved.

• Vascular: Raynaud phenomenon (reduced blood flow to extremities) is present in the majority of patients and may exist for several months or years before clinical presentation of scleroderma.
• Gastrointestinal: Dyspepsia, GORD, constipation, fecal incontinence and malnutrition
• Respiratory: Dyspnea (shortness of breath), chest pain and persistent cough. These are usually associated with pulmonary hypertension.
• Musculoskeletal: Pain of the bones, joints and muscles, restricted joint movement and muscle weakness.
• Cardiac: Arrhythmias and congestive heart failure, which is recognizable by shortness of breath.
• Renal: Hypertension and renal insufficiency or crisis.
• Genitourinary: Erectile dysfunction, bladder fibrosis and vaginal fibrosis.
• Eyes, ears, nose and throat: Sicca syndrome, tooth changes, acid reflux resulting in hoarseness and blindness.
• Neurologic/psychiatric: Pain, decreased sensation, headache, depression and anxiety.
• Constitutional: fatigue, loss of appetite and weight loss.

Physical Examination and Tests

There is no single test for scleroderma that is able to effectively determine the involvement of the condition. Most patients present with symmetric thickening of the skin, and many are also affected by Raynaud’s phenomenon.

A skin biopsy of an affected area can be taken and tested in a laboratory setting for signs of scleroderma. These tests are able to identify anti-topoisomerase antibodies (e.g. anti-scl70) that are associated with the diffuse systemic form of the disease or anti-centromere antibodies that are associated with the limited systemic form.

Differential Diagnosis

The diagnosis of scleroderma can sometimes be confused with several other health conditions, including:

• Eosinophilia
• Eosinophilia-myalgia syndrome
• Eosinophilic fasciitis
• Graft-versus-host disease
• Mycosis fungoides
• Nephrogenic systemic fibrosis
• Primary biliary cirrhosis
• Primary pulmonary hypertension
• Complex regional pain syndrome

References

• http://www.niams.nih.gov/Health_Info/Scleroderma/scleroderma_ff.asp#d
• http://emedicine.medscape.com/article/331864-workup
• http://emedicine.medscape.com/article/331864-clinical
• http://www.nhs.uk/conditions/scleroderma/Pages/Introduction.aspx
• http://www.healthline.com/health/scleroderma#Diagnosis4

Further Reading

• Scleroderma - What is Scleroderma?
• Scleroderma History