(A) the limitations of scleroderma (localized scleroderma) according to lesion morphology and distribution can be divided into: drop-shaped scleroderma, scleroderma sheet, ribbon, and generalized scleroderma hardcover glass
(B) systemic sclerosis (systemic scleroderma) according to the scope of involvement, extent, speed of progress and prognosis, etc., can be divided into: acral scleroderma and diffuse-type hardcover glass
(C) the limitations of scleroderma
1. Macular damage to the beginning of round, oval or irregular-shaped, pink or purple edematous fat hard piece block damage. A few weeks or months after the gradual expansion of up to 1 ~ 10cm in diameter or larger, color slowed, pale yellow or ivory, lilac or pale around the usually red halo around. Dry and smooth surface, showing wax-like luster, touch of the leather-like hardness, and sometimes accompanied by telangiectasia. Local is not sweating, nor hair. Damage can be single or multiple. After a slow, a few years later to reduce the hardness and gradually appear white or light brown atrophic scars. Can occur at any site, but the trunk is more common. In the localized form of this most common, accounting for about 60%.
Generalized morphea rare, its occurrence and development of a similar plaque scleroderma, but the damage is characterized by the number of many large area of skin sclerosis, widely distributed without systemic damage. Good Fat in the abdomen and proximal extremities, but the face, neck, scalp, forearms, calves, etc. can also be involved. Can often combined joint pain, neuralgia, abdominal pain, migraine headaches, and mental disorders. Can be converted to a small number of patients with systemic lupus hardcover glass
2. Zoster damage was often along the limb or intercostal zonal distribution, but are usually of the scalp or the denomination of the Department of occurrence, after the damage with the sheet similar, but significantly depressed lesions, and sometimes the muscles under the skin lesions, and even bones may have decalcification, osteoporosis, absorption thinning. More common in children.
3. Guttate the damage occurred mostly in neck, chest, shoulders, back, etc., damage to soybeans for the mung bean clustering or large linear array of small spots of hair hard. Smooth, shiny surface, was mother of pearl or ivory, surrounded by pigmentation, longer than a long time, atrophy may occur. This type of relatively rare.
(Iv) systemic sclerosis, acral type and diffuse the main difference lies in acral type began in the hands, feet, face, etc., involved a relatively limited scope, the pace slower and better prognosis. In view of the clinical symptoms similar to type 2 and are summarized as described below:
1. Skin can be divided into edema, hardening and shrinkage 3.
⑴ edema period: tight skin, thickening, wrinkles disappear, pale or yellow, skin temperature is low, showing non-pitting edema. Acral-type edema usually start with hands, feet and face started to upper limbs, neck, shoulder, etc. spread. In the diffuse type, then from the trunk is often the first disease, and then extended to the surrounding.
⑵ hardening period: the skin hardens, the surface of wax-like luster, can not use your fingers Nieqi. According to the different parts of the skin involvement can produce finger flexion is limited, a fixed facial expression, mouth and eyes closed difficulties, chest Jinshu flu symptoms. Affected area of skin pigmentation, can be mixed with pigment faded spots, hair sparse, while there is skin itching or paresthesia.
⑶ atrophy period: thin as parchment-like skin atrophy, and even occurred in subcutaneous tissue and muscles atrophy and sclerosis, close to bone, forming a hard wood-like pieces. Fingertip and joints prone to refractory ulcers, and a little sweat-infested areas, and the phenomenon of hair loss. A few cases, there may be telangiectasia.
The skin lesions in a variety of scleroderma is a very common, but it is worth noting that, there are no symptoms of skin sclerosis exist.
Involvement is not uncommon, symptoms include muscle weakness, diffuse pain. Some cases can seem onset of clinical manifestations of myositis, muscle involvement can attack marked muscle atrophy.
3. Bone and joint pain, swelling the first section were related to about 12%, in the course of the disease to develop into a joint change in 46%, showing mild activity since the disruption to ankylosis resulting in contracture deformities. The most common changes hands, fingers can be rigid, or shorter and deformation. Bone resorption finger tip was cut out to shape the performance.
⑴ digestive system: the activities of the tongue may be limited due to tie contracture, teeth become loose due to apical absorption, esophageal involvement are quite common (45% ~ 90%), manifested as difficulty in swallowing, it usually involves vomiting, retrosternal or upper abdomen a sense of fullness or burning (due to reflux esophagitis caused by). Gastrointestinal tract involvement may have loss of appetite, abdominal pain, abdominal distention, diarrhea alternating with constipation and so on.
⑵ cardiovascular system: about 61% of the patients have varying degrees of heart involvement. Myocarditis, pericarditis, or endocarditis have occurred. Clinical manifestations of shortness of breath, chest tightness, angina and cardiac arrhythmia, severe cases can cause left ventricular or whole-hearted failure (due to lung damage may also result in pulmonary heart disease caused by right heart failure), or even sudden cardiac death. The performance of ECG abnormalities.
⑶ Respiratory: Pulmonary involvement may occur when extensive pulmonary interstitial fibrosis, reduced lung capacity, the clinical manifestations of cough and progressive shortness of breath.
⑷ urinary system: kidney involvement accounts for about 75%, may occur sclerosing glomerulonephritis inflammation, to chronic proteinuria, hypertension and azotemia, severe cases can cause acute renal failure.
⑸ neuropsychiatric system: a few cases, multiple neuritis (including cranial nerves), convulsions, epileptic seizures, personality changes, cerebral arteriosclerosis, cerebral hemorrhage, as well as increased protein in cerebrospinal fluid and abnormal EEG.
Can still have Raynaud's phenomenon (mostly occur in extremities); in the fingers or other joints or limbs stretching around the side of cotton fabric with soft tissue calcium deposition; some cases of active in scleroderma irregular intermittent fever, fatigue and the weight loss and other systemic symptoms.