For any condition that manifests itself to the GP with skin involvement, looking at images can be one of the main aids for making sure you do not miss the diagnosis.
Scleroderma is one such condition, and the best collection of pictures can be found on this website. There are 20 of them, and the quality of the photographs is excellent, even when fully enlarged. Each image is accompanied by a brief case description as well as physician’s comments on diagnosis and management.
The best pictures of classic sclerodactyly are found in the second set of images. It is easy to miss the link to these — look for the arrows where it says ‘next result set’.
Why go there: observe and remember.
Downside: clinical detail is minimal.
Information from: DermAtlas.
This rather detailed account of scleroderma starts off by telling those of us who did not have the benefit of a classical education that the term scleroderma is derived from the Greek words skleros, meaning hard or indurated, and derma, meaning skin. Apparently Hippocrates first described this condition, so it has been around a long time.
There follows the usual description of clinical signs, and a relatively short list of differential diagnoses. The table listing treatments is well worth a look, and right at the end there are a number of slides and X-rays that are your reward for making it to the end.
Why go there: covers everything.
Downside: too much for a quick read.
Information from: Division of Rheumatology, Thomas Jefferson University.
This is one of those pages that are ostensibly written for patients, but in fact contains more than enough detail for a GP.
These pages deal mainly with the complications of scleroderma, but starts by telling us that patients with CREST scleroderma (calcinosis, esophageal problems, Raynaud’s, sclerodactyly and telangiectasia) usually have a favourable outlook and normal lifespan.
Those with the diffuse form, however, may develop pulmonary fibrosis, renal involvement, myocardial damage, and problems affecting the upper and lower GI tract.
It should not be forgotten that the social impairment induced by this condition often causes significant depression, and it is also worth filing away the fact that about half of all patients with scleroderma develop hypothyroidism.
Why go there: relatively brief.
Downside: no images.
Information from: University of Maryland Medical Center.
This UK charity is worth noting as somewhere to send your patients for sensible, independent information.
I am not that keen on charity websites whose homepage is concerned mainly with fund raising. My feeling is that when someone visits such a website, the first thing they want to see is friendly information, not requests for money — but perhaps I am being uncharitable. So tell your patients that there is a link on this homepage that will take them to information about the condition.
There is also a menu that lists frequently asked questions and some helpful publications.
This website is a bit plain and I hope that when it is next updated, someone with a little imagination will liven it up and use some images.
Why go there: helpful for sufferers.
Information from: Scleroderma Society.
Any condition for which there is no cure will attract vast numbers of unproven remedies. This one is no exception.
What this site purports to offer is a cocktail of 11 ingredients (rather quaintly, it calls them ‘servings’) that are ‘doctor-designed to therapeutically help your arteries and help break down cross links which may affect fibrosis’. The ‘serving size’ (is this a pharmacy or a restaurant?) is six capsules twice a day.
The idea behind this appears to be that flushing heavy metals from the body increases mitochondrial activity, and there’s some other guff about ‘the natural chelating actions of orotates and aspartates of potassium and magnesium’ that are ‘clinically observed.’ Now that is a good phrase — you can observe almost anything clinically.
The course of 60 capsules cost £43; as they will last for five days, I make that an outlay of £215 a month. But don’t worry, the capsules are guaranteed not to contain any sugar, starch, salt, wheat gluten, colouring or flavouring. Must be worth the money, then.
Why go there: why, indeed?
Downside: no need to spell it out.
Information from: World Wide Health Center.net
- Dr Barnard is a former GP in Fareham, Hampshire