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Treatment of Scleroderma
Allen N. Sapadin, MD;
Raul Fleischmajer, MD
Arch Dermatol. 2002;138:99-105.
The treatment of systemic sclerosis (scleroderma) is difficult and remains
a great challenge to the clinician. Because the cause is unknown, therapies
are directed to improve peripheral blood circulation with vasodilators and
antiplatelet aggregation drugs, to prevent the synthesis and release of harmful
cytokines with immunosuppressant drugs, and to inhibit or reduce fibrosis
with agents that reduce collagen synthesis or enhance collagenase production.
The purpose of this review is to critically analyze conventional and new treatments
of systemic sclerosis and localized scleroderma. The therapeutic options discussed
for the treatment of systemic sclerosis include the use of (1) vasodilators
(calcium channel blockers [nifedipine], angiotensin-converting enzyme inhibitors
[captopril, losartan potassium], and prostaglandins [iloprost, epoprostenol]),
(2) immunosuppressant drugs (methotrexate, cyclosporine, cyclophosphamide,
and extracorporeal photopheresis), and (3) antifibrotic agents (D-penicillamine,
colchicine, interferon gamma, and relaxin). The treatment options reviewed
for localized scleroderma include the use of corticosteroids, vitamin D analogues
(calcitriol, calcipotriene), UV-A, and methotrexate. Preliminary reports on
new therapies for systemic sclerosis are also considered. These include the
use of minocycline, psoralen–UV-A, lung transplantation, autologous
stem cell transplantation, etanercept, and thalidomide.
From the Department of Dermatology, Mount Sinai School of Medicine,
New York, NY.
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Morphea presenting as widespread oedema
Dobbie et al.
JRSM 2002;95:459-460.
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