Systemic sclerosis - current concepts of skin and systemic manifestations

Publication date: Available online 12 April 2018
Source:Clinics in Dermatology
Author(s): David R. Pearson, Victoria P. Werth, Lisa Pappas-Taffer
Systemic sclerosis is an uncommon autoimmune connective tissue disease with multi-organ system involvement and significant associated morbidity and mortality. Cutaneous signs and symptoms are of particular importance as they may be recognized before systemic manifestations, allowing earlier risk stratification into the limited and diffuse cutaneous subtypes, as well as earlier initiation of treatment. Important cutaneous manifestations include Raynaud's phenomenon, digital ulcers, cutaneous sclerosis, calcinosis cutis, telangiectasias, pruritus, and dyspigmentation. Despite investigation of a wide variety of treatments, no FDA-approved pharmacologic therapies exist for systemic sclerosis, and data from high quality studies are limited. In the following review, we will discuss skin-directed therapies. While there is evidence to support specific treatments for Raynaud's phenomenon, digital ulcers, and cutaneous sclerosis, there are limited rigorous studies evaluating the treatment of other cutaneous signs and symptoms. Additional randomized-controlled trials and large observational studies are necessary to develop future evidence-based treatment options.