Scleroderma is an autoimmune disease that affects women 4 times more than men. While its cause is unclear, its symptoms are due to an overproduction of collogen and hardening (sclerosis) of the tissues of the body. Scleroderma can manifest in many ways. It can be local or systemic. It can affect the skin, blood vessels and organs. The most common symptom is changes in the color of the skin and tightening and thickening of the skin.
In localized scleroderma two types of lesions can occur; morphea, which shows as oval patches on the trunk, face and extremities that start as dry, thickened skin and progress to pale centers with purple edges, or linear, where a discolored line or band on arms, legs or forehead appear resembling a scar from a long cut. Localized scleroderma is usually self-limiting and may resolve over time.
Systemic scleroderma is a more serious form of the disease that can involve skin, blood vessels, and organs especially the heart, kidneys, lungs and digestive tract. There are 3 forms; limited systemic scleroderma which has a slow onset and progression but can eventually affect the organs, diffuse scleroderma which has a sudden onset and more rapidly involves the organs, and sine scleroderma which only involves the organs and doesn't manifest in the skin at all.
CREST is the acronym for the common symptoms of scleroderma and stands for Calcinosis, calcium deposits in the skin especially in the fingers, Raynaud's phenomenon, impaired circulation and vascular spasm in the extremities, Esophageal dysmotility or sluggish digestion with reflux, Sclerodactyly, which is hardening of the fingers, and Telangiectasia or discoloration of the skin.
Systemic scleroderma can cause major health problems as it progresses. Ulcerations of the skin can lead to infection and gangrene while fibrosis of lungs, kidney and heart can lead to failure of these organs. While most often a long term, chronic disease systemic scleroderma can be fatal.
Treatment is supportive with immunosuppressant drugs, corticosteroids, pain relievers, and other drugs depending on the symptoms. Physical and occupational therapy are also utilized to help maintain movement and flexibility of the joints as long as possible.
Massage therapy will need to be adjusted depending on the type of scleroderma, the individual symptoms and the severity of the disease. Myofascial techniques will generally be ineffective due to changes in the tissue itself. Deep tissue may be cautioned or contraindicated if skin hardening is severe and circulation compromised. Gentle relaxation massage that is firm and rhythmic can help improve circulation and be soothing to tight tissues as well as help the client to deal with the stress and pain of a chronic disease. Passive and active movement of the joints can also be of help but should be gentle and never forced beyond the physiologic barriers. Energy work and breath work are some of the other modalities that may be used even when massage may be contraindicated.
Further information on this topic can be found at http://www.mayoclinic.com/health/scleroderma/DS00362 , http://www.scleroderma.org/ , or http://www.niams.nih.gov/Health_Info/Scleroderma/default.asp
Jean Wible is a Registerd Nurse, Nationally Certified and Licensed Massage Therapist and Healing Touch Certified Practitioner. Author of "Pharmacology for Massage Therapy" and "Drug Handbook for Massage Therapists" and faculty at the Associate Degree Program in Massage Therapy at The Community College of Baltimore County.
In localized scleroderma two types of lesions can occur; morphea, which shows as oval patches on the trunk, face and extremities that start as dry, thickened skin and progress to pale centers with purple edges, or linear, where a discolored line or band on arms, legs or forehead appear resembling a scar from a long cut. Localized scleroderma is usually self-limiting and may resolve over time.
Systemic scleroderma is a more serious form of the disease that can involve skin, blood vessels, and organs especially the heart, kidneys, lungs and digestive tract. There are 3 forms; limited systemic scleroderma which has a slow onset and progression but can eventually affect the organs, diffuse scleroderma which has a sudden onset and more rapidly involves the organs, and sine scleroderma which only involves the organs and doesn't manifest in the skin at all.
CREST is the acronym for the common symptoms of scleroderma and stands for Calcinosis, calcium deposits in the skin especially in the fingers, Raynaud's phenomenon, impaired circulation and vascular spasm in the extremities, Esophageal dysmotility or sluggish digestion with reflux, Sclerodactyly, which is hardening of the fingers, and Telangiectasia or discoloration of the skin.
Systemic scleroderma can cause major health problems as it progresses. Ulcerations of the skin can lead to infection and gangrene while fibrosis of lungs, kidney and heart can lead to failure of these organs. While most often a long term, chronic disease systemic scleroderma can be fatal.
Treatment is supportive with immunosuppressant drugs, corticosteroids, pain relievers, and other drugs depending on the symptoms. Physical and occupational therapy are also utilized to help maintain movement and flexibility of the joints as long as possible.
Massage therapy will need to be adjusted depending on the type of scleroderma, the individual symptoms and the severity of the disease. Myofascial techniques will generally be ineffective due to changes in the tissue itself. Deep tissue may be cautioned or contraindicated if skin hardening is severe and circulation compromised. Gentle relaxation massage that is firm and rhythmic can help improve circulation and be soothing to tight tissues as well as help the client to deal with the stress and pain of a chronic disease. Passive and active movement of the joints can also be of help but should be gentle and never forced beyond the physiologic barriers. Energy work and breath work are some of the other modalities that may be used even when massage may be contraindicated.
Further information on this topic can be found at http://www.mayoclinic.com/health/scleroderma/DS00362 , http://www.scleroderma.org/ , or http://www.niams.nih.gov/Health_Info/Scleroderma/default.asp
Jean Wible is a Registerd Nurse, Nationally Certified and Licensed Massage Therapist and Healing Touch Certified Practitioner. Author of "Pharmacology for Massage Therapy" and "Drug Handbook for Massage Therapists" and faculty at the Associate Degree Program in Massage Therapy at The Community College of Baltimore County.
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