Scleroderma: Types, Symptoms and Dermatology Treatment Options
At Advanced Dermatology, P.C., we help patients across New York and New Jersey understand and manage skin conditions like scleroderma. It is a chronic autoimmune disease that causes too much collagen, leading to skin tightening and, in some cases, damage to internal organs. Early dermatologic evaluation is key.
What Is Scleroderma?
Scleroderma is a chronic autoimmune disorder where the immune system attacks healthy tissue by mistake. This leads to too much collagen, the protein that gives skin and connective tissue their structure and strength The excess collagen causes the skin to harden, thicken and tighten.
Scleroderma can also affect blood vessels and internal organs, including the lungs, heart, kidneys and digestive system. How much it affects the body widely by type. While there is no cure, treatments can help manage symptoms and slow progression. Dermatologists play a key role in finding and treating skin symptoms, often working with rheumatologists and other specialists.
Types of Scleroderma
Scleroderma is broadly divided into two categories: localized and systemic. It is important to understand the difference between these forms because they vary in severity and which organs they affect.
According to the Scleroderma Foundation, approximately 300,000 Americans are living with scleroderma. Of those, roughly one-third have the systemic form of the disease. Women are affected more often and develop scleroderma about four times more than men.
Localized Scleroderma (Morphea)
Localized scleroderma usually appears only on the skin and the tissues directly beneath it, and it does not affect other organs. It is the most common form of scleroderma and is often called morphea. There are three main subtypes:
- Circumscribed Morphea
The most common form of localized scleroderma, circumscribed morphea presents as isolated, oval-shaped patches of skin that become thick and hard over time. These patches may have a yellow or waxy center with a red or purple border. They can vary in size and number and may appear anywhere on the body. - Generalized Morphea
In this more extensive form, larger and more widespread patches of thickened skin develop across multiple areas of the body. Generalized morphea can cause noticeable skin changes and may sometimes affect deeper tissues. - Linear Scleroderma
This subtype appears as a line or streak of thickened, discolored skin, most often running down a limb or across the forehead. Linear scleroderma is more common in children and can affect the muscle and bone underneath, sometimes affecting growth or movement.
Systemic Scleroderma
Systemic scleroderma, also called systemic sclerosis, affects not only the skin but also the vascular system and internal organs. It is the more serious form of the disease and has three main types:
- Limited Scleroderma (CREST Syndrome)
A slow-progressing form affecting the skin of the fingers, hands, face and lower limbs. CREST stands for Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly and Telangiectasia. - Diffuse Scleroderma
This subtype involves more rapid and widespread skin thickening that can extend to the trunk and limbs. - Sine Sclerosis
A rare form of systemic scleroderma, sine sclerosis is notable for causing internal organ damage without the typical skin thickening seen in other subtypes. Because the skin does not show changes, this form can be harder to diagnose.
Symptoms of Scleroderma
Scleroderma can cause a wide range of symptoms, from isolated skin changes to widespread systemic effects. The symptoms a patient experiences depend largely on the type of scleroderma they have, and which parts of the body are involved.
Skin Symptoms (Tightening, Shiny Skin or Patches)
Affected skin becomes tight, thick and shiny due to collagen buildup. Discolored patches, ranging from reddish to pale or waxy, are common in localized forms. The skin may stop sweating, become very dry and break down. Hair loss in affected areas is also common.
Raynaud’s Phenomenon
Raynaud’s phenomenon is often the first sign of scleroderma. It occurs when blood vessels in the fingers and toes spasm in response to cold or stress, causing the skin to turn white, then blue, then red. It often causes numbness, tingling or pain and can lead to sores on the fingertips if left unmanaged.
Joint Pain and Mobility Changes
Skin tightening over joints like the fingers, wrists or jaw can limit movement and make everyday tasks harder. Physical therapy is often recommended to preserve flexibility, as hardening can extend to the underlying muscle, causing further weakness.
Systemic Organ Involvement
In systemic forms, the lungs, heart, kidneys and gastrointestinal tract can all be affected, causing symptoms such as shortness of breath, difficulty swallowing or acid reflux. Recognizing these signs helps dermatologist’s make sure patients get coordinated, multidisciplinary care.
Causes and Risk Factors
The exact cause of scleroderma is not fully understood. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), researchers believe the immune system overreacts and causes inflammation and injury to the cells lining blood vessels. This process causes connective tissue cells, especially fibroblasts, to make too much collagen, which builds up in the skin and organs.
Several factors are thought to influence a person’s risk of developing scleroderma:
- Immune System Dysfunction
An abnormal immune response is considered the primary driver of scleroderma. The immune system mistakenly attacks healthy tissue, causing inflammation and too much collagen production. - Genetic Factors
Certain genes are associated with an increased susceptibility to scleroderma. A family history of autoimmune conditions may elevate risk, though scleroderma itself is not directly inherited. - Hormonal Influences
Because scleroderma is far more common in women, particularly during childbearing years, hormonal factors are believed to play a contributing role. - Environmental Triggers
Exposure to certain chemicals, silica dust or infections may act as triggers in genetically predisposed individuals.
How Dermatology Fits Into Scleroderma Management
Medical dermatology plays a central, often first-line role in recognizing and managing scleroderma. At Advanced Dermatology, P.C., our dermatologists are experienced in evaluating skin manifestations, from initial diagnosis to ongoing monitoring and treatment.
Skin Monitoring and Early Diagnosis
Because scleroderma symptoms can look like other autoimmune conditions, early evaluation is important. Our dermatologists conduct thorough skin examinations, may perform a biopsy and use blood screening for antinuclear antibodies (ANA) and scleroderma-specific antibodies to determine whether the condition is localized or systemic.
Topical and Laser Treatments for Skin Changes
For skin-focused symptoms, Advanced Dermatology, P.C. dermatologists offer cosmetic dermatology services that help minimize the aesthetic skin changes. These treatments include topical therapies, such as corticosteroid creams, tacrolimus and vitamin D analogs to reduce inflammation and slow skin thickening. Phototherapy is effective for morphea patches and discoloration, while laser treatments can address telangiectasias and pigmentation changes.
Coordinated Care with Rheumatology
For systemic scleroderma, Advanced Dermatology, P.C. dermatologists work closely with rheumatologists and other specialists. While rheumatologists oversee systemic disease management, our dermatologists ensure skin manifestations are properly treated and communicated to the broader care team, facilitating seamless referrals on behalf of every patient.
Frequently Asked Questions
Is scleroderma curable?
Currently, there is no cure for scleroderma. However, a variety of treatments are available to help manage symptoms, slow the progression of the disease and protect organ function. With the right care team and treatment plan, many patients are able to maintain a good quality of life. Research on new treatments is ongoing and mat lead to better outcomes in the future.
What does scleroderma skin feel like?
Skin affected by scleroderma typically feels tight, hard and inflexible. In its early stages, the condition causes skin inflammation or puffiness. As it progresses, the skin becomes firm. Affected areas are often shiny and may be itchy or uncomfortable due to extreme dryness. On the fingers and hands, the tightening can make it difficult to fully open or close the fist.
Can scleroderma affect only the skin?
In its localized form, scleroderma primarily affects the skin and the tissues directly beneath it, without involving internal organs. Localized scleroderma (morphea) is generally considered less severe than systemic forms.
What is morphea and is it the same as scleroderma?
Morphea is a form of localized scleroderma. It causes patches of hardened, thickened skin that are typically painless and do not normally affect internal organs or the vascular system. While morphea is technically a type of scleroderma, it is distinct from systemic scleroderma, which can cause widespread organ involvement. Many patients and providers use the term “morphea” specifically to refer to localized skin-only disease.
Which type of doctor should I see for scleroderma?
The right specialist depends on the type of scleroderma you have. For localized scleroderma or skin-focused symptoms, a dermatologist is often the primary point of care. For systemic scleroderma, a rheumatologist typically leads management, though dermatologists remain important partners in treating skin manifestations. Many patients benefit from a coordinated care approach involving both specialties, along with other physicians as needed depending on which organs are affected.
See a Dermatologist for Scleroderma in NY & NJ
If you have skin tightening, unusual patches, Raynaud’s phenomenon or joint stiffness, a dermatology evaluation is an important first step. At Advanced Dermatology, P.C., our board-certified dermatologists provide expert care for scleroderma patients across New York and New Jersey. Schedule a consultation at any Advanced Dermatology, P.C. location today.