General: Treatment for scleroderma focuses on reducing the symptoms. Patients with scleroderma should visit their healthcare providers regularly to monitor their condition and help slow the progression of the disease.
Regular exercise: Patients with scleroderma should exercise regularly to maintain as much strength and flexibility as possible. There are many ways to exercise, including gardening, walking, sports activities, and dancing.
Patients should choose exercise programs that fit with their levels of strength and endurance. Exercise that causes extreme pain or discomfort may be harmful because it may lead to torn ligaments, pulled muscles, or sprained joints. Not everyone is able to handle intense types of exercise, such as tennis or running. According to the American Academy of Physicians, individuals who are pregnant or have bone disease or nerve injuries should participate in low-impact forms of exercise, such as walking or swimming. Individuals should talk with their healthcare providers before starting a new exercise plan.
Humidifiers: Patients with scleroderma may benefit from a humidifier, which increases the amount of moisture in the air. This helps prevent the skin from becoming dry.
Oil-based lotions: Oil-based creams and lotions may also help prevent the skin from becoming excessively dry. Creams should be applied frequently, especially after bathing or showering.
Changing eating habits: If scleroderma affects the gastrointestinal tract, patients may need to change their eating habits. Eating smaller, more frequent meals may reduce symptoms of heartburn. Avoiding late-night meals, spicy foods, fatty foods, alcohol, and caffeine may also help prevent digestive symptoms. Multivitamins may also be beneficial for patients who experience decreased nutrient absorption as a result of gastrointestinal damage. However, it is recommended that patients talk to their healthcare providers before taking dietary supplements.
Medications called nonsteroidal anti-inflammatory drugs (NSAIDs) are often taken to reduce joint pain and inflammation associated with scleroderma. Medications, such as ibuprofen (Motrin® or Advil®), are commonly used.
The frequency and severity of NSAID side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum. Patients taking NSAIDs who have a history of gastrointestinal problems should consider taking a medication to protect the stomach, such as misoprostol (Cytotec®).
Disease-modifying antirheumatic drugs (DMARDs): Healthcare providers often prescribe disease-modifying antirheumatic drugs (DMARDs). These medications are called "disease-modifying" drugs because they slow the progression of scleroderma. These drugs may take weeks to months before they begin to take effect. Therefore, they are often used in combination with NSAIDs or corticosteroids. Commonly prescribed DMARDs include the gold compound auranofin (Ridaura®), hydroxychloroquine (Plaquenil®), sulfasalazine (Azulfidine®), and methotrexate (Rheumatrex®).
Immunosuppressants: Because scleroderma occurs when the immune system attacks the person's own body, patients often take medications called immunosuppressants. Immunosuppressants weaken the body's immune system, which helps reduce symptoms of scleroderma. Commonly prescribed immunosuppressants include leflunomide (Arava®), azathioprine (Imuran®), cyclosporine (Neoral® or Sandimmune®), and cyclophosphamide (Cytoxan®).
These medications may have serious side effects, including increased risk of infections, kidney problems, high blood pressure, and decreased levels of red blood cells. Other side effects may include increased hair growth, loss of appetite, vomiting, and upset stomach.
Calcium channel blockers: Severe cases of Raynaud's phenomenon may be treated with calcium channel blockers, such as nifedipine (Procardia®). These medications help open the small blood vessels and improve circulation.
Antihypertensives: Patients with pulmonary hypertension may benefit from antihypertensives such as prostacyclin (Iloprost®). These prescription-strength medications decrease the blood pressure in the arteries leading to the lungs.
Antacids: If scleroderma has caused esophageal damage and is causing heartburn, patients typically take antacids. These medications reduce the amount of stomach acid that is produced, and help reduce heartburn. Some over-the-counter H-2 receptor blockers, such as cimetidine (Tagamet HB®), famotidine (Pepcid AC®), nizatidine (Axid AR®), and ranitidine (Zantac 75®), may help provide quick relief of symptoms. Side effects of H-2 receptor blockers, which are uncommon, may include changes in bowel movements, dry mouth, dizziness, or drowsiness. Proton pump inhibitors, such as omeprazole (Prilosec OTC®), may also be taken short-term to help the esophagus heal. Patients should not take these medications long term unless they talk with their healthcare providers first.
Patients with persistent heartburn may require prescription-strength medications to manage symptoms and prevent esophageal damage. H-2 blockers, such as Axid®, Pepcid®, Tagamet®, and Zantac®, are commonly prescribed. Examples of prescription-strength proton pump inhibitors include esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).
Unclear or conflicting scientific evidence
Para-aminobenzoic acid (PABA): Potassium para-aminobenzoate (KPAB) has been proposed as a treatment for sclerodermatous skin changes. Clinical reviews have suggested the effectiveness of KPAB in the management of scleroderma, particularly with respect to skin changes, survival rate, and pulmonary function. However, clinical study on KPAB for management of sclerodermatous skin changes did not reveal any effect. The use of KPAB as a therapy in scleroderma remains controversial. Additional high quality clinical study is warranted.
Avoid oral use in children and pregnant or nursing women. Avoid with known hypersensitivity to PABA or its derivatives. Use cautiously in patients with renal disease. Abnormalities of liver function tests have been noted in patients taking PABA. Discontinue use if rash, nausea, or anorexia occurs. PABA should not be given concurrently with sulfonamides. Use cautiously in patients with bleeding disorders or taking anticoagulants. Use cautiously in patients with diabetes or hypoglycemia.
Fair negative scientific evidence
DMSO (dimethyl sulfoxide): DMSO is naturally found in vegetables, fruits, grains, and animal products. It is also available as a dietary supplement. Research suggests that DMSO does not help treat scleroderma. Therefore, it is not recommended for this use.
Avoid if allergic DMSO. Use cautiously with urinary tract cancer, liver disorders, or kidney disorders. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Traditional or theoretical uses lacking sufficient evidence
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific points that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Traditionally, acupuncture has been used to treat scleroderma. However, scientific studies are needed to determine if this treatment is safe and effective.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origin, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants. Avoid if pregnant.
Avocado: Avocados are fruits that are a nutritious source of potassium. Although avocado has been suggested as a possible treatment for scleroderma, scientific studies are lacking in this area. Human studies are needed to determine if avocados are safe and effective for this condition.
Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Avoid if taking monoamine oxidase inhibitors (MAOIs). Use cautiously if taking anticoagulants (blood thinners). Doses greater than those found in a normal diet are not recommended if pregnant or breastfeeding. Some types of avocado may be unsafe when breastfeeding.
Bromelain: Bromelain is an herb that contains a digestive enzyme that comes from the stem and the fruit of the pineapple plant. It has been proposed that bromelain may help treat symptoms of scleroderma. However, human studies have not evaluated the safety and efficacy of this therapy. Well-designed research is warranted in this area.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceaefamily. Avoid with liver disease, kidney disease, or bleeding disorders. Use cautiously with bleeding disorders, stomach ulcers, high blood pressure, or acute genitourinary tract inflammation. Use cautiously before dental or surgical procedures or while driving or operating machinery. Use cautiously in children younger than two years of age. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. Theoretically, hydrotherapy may help treat scleroderma. Well-designed studies are needed to determine if this therapy is safe and effective for scleroderma patients.
Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices (e.g. pacemakers, defibrillators, or liver infusion pumps). Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
Niacin: Niacin (a component of vitamin B3) is a B-complex vitamin found in a many foods, including liver, poultry, fish, nuts, and dried beans. It is needed for the nervous system and gastrointestinal tract function. Although niacin has been suggested as a possible treatment for scleroderma, scientific evidence is lacking. Well-designed studies are needed to draw a firm conclusion in this area.
Avoid niacin or vitamin B3 if allergic to niacin or niacinamide. Use cautiously with peptic ulcer disease, diabetes mellitus, or gout. Avoid with liver disorders. Periodic monitoring of homocysteine levels may be warranted because niacin has been shown to increase homocysteine levels up to 55%. If pregnant or breastfeeding, niacin supplements should be only be taken under the supervision of a healthcare provider.
Organic food: In the United States, a product is considered "organic" if the food, the farm, handlers, and processors of that food all meet specific criteria from the U.S. Department of Agriculture (USDA). These criteria include that livestock receive no antibiotics or growth hormones and that produce is grown without most conventional pesticides, or synthetic or sewage sludge-based fertilizers. It has been suggested, but not scientifically proven, that organic food may help treat symptoms of scleroderma. In order to determine if organic food helps with this condition, well-designed scientific studies must be performed.
There is currently a lack of available safety information on organic food due to a lack of scientific research. Organic food is generally assumed to be at least as safe as conventional foods.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Although physical therapy has been used to treat scleroderma, studies have not been performed to determine the safety and efficacy of this treatment. Further research is warranted in this area.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Although vitamin D has been proposed as a possible treatment for scleroderma, scientific studies have not evaluated the safety or efficacy of this therapy.
Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses. Doses higher than recommended may cause toxic effects. Individuals with overactive thyroids, kidney disease, sarcoidosis, tuberculosis, or histoplasmosis have a higher risk of experiencing toxic effects. Vitamin D is generally considered safe for pregnant women. It may be necessary to give infants vitamin D supplements along with breast milk in order to prevent vitamin deficiencies.
Currently, there is no known method of prevention for scleroderma.
Patients who are diagnosed with scleroderma should visit their healthcare providers regularly to monitor their conditions. Properly managing the symptoms of the disease may help increase the patient's quality of life and help slow the progression of the disease.