Scleroderma Skin Involvement: Overview

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Alopecia (Hair Loss)
Calcinosis (Calcium Deposits)
Collagen, Facelifts
Digital Ulcers
Edema (Swelling)
Elbow Tip Pain
Fingernails, Nailfolds, Cuticles
Itching (Pruritus)
Lower Extremity Ulcers
Microstomia (Small Mouth)
Neck Sign
Sclerodactyly (Sclero in Hands)
Skin Fibrosis
Skin Viscoelasticity
Telangiectasia (Red Dots)
Wound Care
Xerosis (Dry Skin)


Skin involvement in systemic sclerosis, which includes both limited/CREST and diffuse scleroderma, can include hair loss, calcium deposits, open sores, swelling, gangrene, changes in skin color, itching, small mouth, swollen or hardened skin on fingers or elsewhere, and dry skin. When skin hardens on the fingers, it is called sclerodactyly. (Also see What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis)

Frontiers in translational systemic sclerosis (SSc) research: a focus on the unmet 'cutaneous' clinical needs (Viewpoint). This viewpoint considers four cutaneous unmet clinical needs of patients with Ssc, which cause pain, disability, and/or disfigurement, all impact on quality of life, and for each we require effective treatments. PubMed, Exp Dermatol, 08/25/2020.

Patterns and predictors of skin score change in early diffuse systemic sclerosis from the European Scleroderma Observational Study. Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in randomised controlled trials. PubMed, Ann Rheum Dis, 2018 Apr;77(4):563-570.

Alopecia (Hair Loss)

Alopecia (hair loss) may occur with scleroderma, if it affects the scalp. ISN.

Overview of Alopecia (Hair Loss)
Alopecia and Autoimmune Diseases
Alopecia and Scleroderma
Alopecia Causes
Alopecia Treatments
Alopecia Research
Alopecia Personal Stories


Calcinosis. The systemic forms of scleroderma can cause small white calcium lumps to form under the skin on fingers or other areas of the body. ISN.

Photos of Calcinosis

Collagen, Face Lifts and Scleroderma

Collagen, Face Lifts, and Scleroderma. Collagen injections should be used with caution in people who have had certain autoimmune diseases. ISN.

Overview of Collagen Injections
Collagen Injections and Autoimmune Diseases
Face Lifts and Scleroderma
Scleroderma Lips
As Cause of Autoimmune Diseases
Repair for Linear/Morphea Scleroderma

Digital (Finger) Ulcers

Digital Ulcers. Systemic scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers. ISN.

Sentinal Sign
-- Surgical
-- Topical
Digital Ulcer Stories
Prevention & Treatment
Raynaud's Stories

Edema (Swelling)

In the initial stages, the systemic forms of scleroderma may cause edema (swelling) in the fingers.

Elbow Tip Pain

Scleroderma Elbow Tip Pains "A common area of involvement of this condition is the skin over the tips of the elbows (the olecranon area). When this skin is involved, it can lead to troublesome irritation of the tips of the elbows with tenderness noted when any pressure is applied." MedicineNet.

Fingernails, Nailfolds, and Cuticles

Fingernails, Nailfolds, and Cuticles. The systemic forms of scleroderma can cause the fingernails to become smaller, and cuticles to become hard or rough. ISN.

Cuticles: Periungual Erythema
Fingernail Abnormalities
Causes of Fingernail Symptoms and Abnormalities
Lack of Fingerprints
Manicure Safety
Nail Biting
Nailfold Capillaroscopy

Gangrene (Death of Tissue)

Gangrene and Amputations. Severe cases of scleroderma and Raynaud's may cause a total lack of blood supply to the extremities. When this happens, necrosis (death of tissue) and gangrene may set in, sometimes making it necessary to have the affected part(s) amputated. ISN.

Causes of Gangrene
Scleroderma and Smoking
Photos of Gangrene
Personal Stories
Related Pages

Hypopigmentation and Hyperpigmentation

Hypopigmentation and Hyperpigmentation. Systemic sclerosis (SSc) such as limited or diffuse scleroderma, can cause hyperpigmentation (darkening) and hypopigmention (lightening) of the skin, usually in the areas which have been affected by skin hardening. ISN.

Drug-Induced: Minocycline
Drug-Induced: Plaquenil
Salt and Pepper Appearance
Ultraviolet Light Therapy

Itching (Pruritus)

Itching may precede and accompany skin tightening in limited and diffuse systemic sclerosis (lSSc, dSSc, SSc). It is caused by the inflammation, and is a temporary phase. ISN.

Itching Emergency
Drug-Induced Skin Itching
Itching QOL and Disability
Treatments for Itching
Xerosis (Dry Skin)

Lower Extremity Ulcers (Leg and Foot Ulcers)

Case Report: Successful Use of Hyperbaric Oxygen as Adjunctive Therapy for a Nonhealing Venous Ulcer in a Patient with Systemic Sclerosis (SSc) and Pulmonary Arterial Hypertension (PAH). We present the case of a 65-year-old female with limited SSc complicated by severe PAH and a nonhealing left lower extremity venous ulcer. PubMed, Case Rep Pulmonol.

Case report: Management of nonhealing venous ulcer in systemic sclerosis with leech therapy. It is concluded that leech therapy with Ayurvedic medicines is highly effective for the management of nonhealing venous ulcers. PubMed, J Family Med Prim Care.

Microstomia: Mouth Involvement in Systemic Scleroderma

Microstomia (Small Mouth) in a Scleroderma Patient, ISN Photo RepositoryMicrostomia. Systemic scleroderma can cause the mouth area to shrink and harden, which can impair chewing, brushing, flossing, and dental work. When the mouth becomes smaller, it is called "microstomia". ISN.

Microstomia (Small Mouth) and Scleroderma
Prevention of Microstomia
Treatments for Microstomia
Microstomia Personal Stories

Neck Sign

The Neck Sign is a distinctive pattern of yellow-brown plaque with beading and ridging. See Scleroderma Photos.


Raynaud's causes blood vessel spasms, which can cause painful coldness, color changes, numbness and tingling. ISN.

Improving Circulation
Rewarming Tips
Heatsock Directions
Tips from Patients
Patient Support
Patient Stories


Sclerodactyly. When fingers and/or toes become tight, stretched, wax-like, and hardened it is called sclerodactyly. ISN.

Sclerodactyly and Scleroderma
Physical Therapy
Sclerodactyly Personal Stories

Skin Fibrosis in Systemic Sclerosis

Skin Fibrosis. Scleroderma is named after skin fibrosis, which is one of its most common and recognizable symptoms. Skin fibrosis eventually develops in most patients. Sclero means "hard" and derma means "skin". ISN.

Physical Therapy
Oral Hygiene
Spontaneous Remission
Myositis (Muscle Inflammation)
Personal Storie

Skin Viscoelasticity

Skin Viscoelasticity. Skin is the largest organ in our body. It protects us from environmental factors, like sunshine and chemicals. It is like elastic, in that it stretches and then snaps back to its original shape and size, which is called viscoelasticity. ISN.

Early Diagnosis of SSc


Telangiectasia may appear on the hands or face. These are tiny red dots, which are caused by blood vessels dilating near the surface of the skin. ISN.

Video Overview
T's in Scleroderma
Cosmetic Warnings
Corrective Cosmetics
Patient Stories

Wound Care

Wound Healing can be a real challenge for many scleroderma patients. Any wound that does not show improvement after a couple of days should be brought to your doctor's attention. ISN.

Xerosis (Dry Skin)

Xerosis may occur from Scleroderma causing the skin to become excessively dry. Very mild soaps and lotions (often baby products) are recommended. ISN.

What is Xerosis?
Bag Balm
Udder Cream
Baby Products
Tips from the Skin Site
The Scleroderma Bath
Go to Alopecia (Hair Loss)

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