Systemic sclerosis (a) with “Salt and Pepper” changes in the skin. Eosinophilic fasciitis (b). Ghosh S, Jain UK, Indian J Dermatol (2013). CC BY-NC-SA 3.0

A physician experienced in systemic sclerosis will usually make the correct diagnosis without any uncertainty. However, in special cases, the diagnosis may be difficult. The suggestions below can be considered.

• bleomycintreatment for cancer.
  • Scleroderma / Systemic Sclerosis -like skin changes (with Raynaud's phenomenon and hard skin)
• Borrelia infection
  • Chronic infection may result Acrodermatis chronica atrophicans
  • Mostly one-sided, blue-violet, thin skin
• Diabetes mellitus
  • Diabetes hand syndrome, "Stiff hand syndrome", Cheiroarthropathy
  • Painless, stiffness in hands
  • Begins at little fingers and spreads against thumbs
  • Hand back with thickened, waxy skin
  • Hard to stretch your fingers
  • Common complication of long-term diabetes mellitus type 1
  • Reference: Goyal A, 2018
• Eosinophilic fasciitis
  • The disease may resemble systemic sclerosis
  • Do not attack your fingers
  • Not Raynaud's phenomenon (like-fingers).
  • Blood and tissue tests (from muscle fascia) show "eosinophilia”In blood test.
  • MRI examination can confirm inflammation of the muscle fascia.
  • Internal organs are not attacked.
  • Tissue test confirms the diagnosis
• Eosinophilia-mylagi syndrome
  • Proven after ingestion of contaminated L-tryptophan (dietary supplement). Epidemiology in 1989
• Eosinophilic myositis (see myositis)
• Low metabolism (hypothyroidism)
  • The disease can cause thick, stiff and swollen skin (soft edema) and swelling.
  • Medical examination with blood sample (TSH, free-T4)
• Linear scleroderma
  • Typically is a string of hard skin (face or elsewhere). This disease does not affect internal organs.
  • Patients are usually followed up by a dermatologist.
  • The exception may be in children there Children's rheumatic section at OUS Rikshospitalet (by NAKBUR) is often contacted
• Morfea
  • This is a skin disease that gives speckled hard skin, often distributed around the body. It can cause pigment changes, but does not attack internal organs and is followed up by a dermatologist. Raynaud's phenomenon is unusual
  • Generalized morphea has widespread skin changes
• Nephrogenic systemic sclerosis
  • Described after MRI with contrast agent when concomitant renal failure occurs.
  • May cause scleroderma-like skin changes, but without Raynaud's phenomenon
• Palmar fasciitis og polyarthritis-syndrome
  • The condition is characterized by increasing contracture (contraction) on the palm side in both hands as in Dupuytren's contracture. This means that fingers cannot be stretched completely and hard connective tissue (fibrosis) can feel in the palms.
  • The syndrome can predict tumor disease, most often ovarian cancer in women
• providone (PVP syndrome)
  • Addicts who illegally dissolve and inject methadone tablets (formerly also Norwegian oral suspension) intended for oral use
  • The injections can cause kidney failure, scleroderma-like changes in the lungs (Pulmonary-vascular injuries), skin and other organs due to an additive, providone, remaining in the body
  • The PVP syndrome is discussed on a separate page here
    • Seen by intravenous drug abuse
• Pseudo-scleroderma
  • These are more or less systemic sclerosis-like skin changes that are seen in relation to Concomitant cancer disease. Rare, para-malignant condition (reference: Querfeld C, 2000)
• Scleroderma their scleroderma
  • This is an extremely rare form of systemic sclerosis without typical skin changes ("scleroderma sine scleroderma"), but otherwise typical symptoms
• Sclero-myositis (overlap form)
• Sclero- myxoedema (Papillary Muscinosis)
• Scleredema (scleredema Buscke)
  • The disease causes hard skin on large parts of the body
  • Not Raynaud's phenomenon
  • Little changes on the fingers.
  • Often diabetes / diabetes is present
• TEMPI syndrome
  • Progredive severe teleangiectasis skin
• Toxic cooking oil syndrome-
  • Intake of damaged, old rapeseed oil caused epidemic in Spain in 1981
  • Symptoms
    • Breathing Problem (Dyspnea)
    • Muscle pain
    • Joint pain and tight joints (contractures)
    • Liquid (edema) in arms and legs
    • Chronic skin changes
    • Livedo reticularis
    • Nerve damage (Neuropathy)

Calcinosis

• Dermatomyositis
  • Calcium most often among children (Juvenile dermatomyositis)
• Hyper-kalsemi
  • PTH and ionized calcium
• Hyper-fosfatemi
  • High phosphate levels and often low blood calcium
• Cutaneous calcinosis
  • Most often after injuries

• More about calcinosis; please read on separate page here
• Necrosis (digital), please read more here (Vaskulitt.no)

• Systemic sclerosis, BINDEVEVSSYKDOMMER.no
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