Nonpharmacological therapy for cutaneous features of systemic sclerosis

The cutaneous features of systemic sclerosis are scleroedema (in the early stage) and scleroderma.

Hand, foot and nail care are important in all stages of scleroderma. Regular application of emollients (eg sorbolene cream) and avoidance of soaps can be useful.

Maintaining range of motion of the hand is very important from the time of diagnosis, and a simple exercise program is recommended. Facial exercises, especially mouth opening, are also important; there is some evidence to suggest facial exercises can facilitate eating, speaking and dental hygiene.

If skin fibrosis is widespread, range-of-motion exercises are recommended. These can be in the form of a gym program, hydrotherapy, a walking program, or a home-based exercise program. Hydrotherapy may not be suitable if skin ulcers are present and may cause worsening of Raynaud phenomenon. Aerobic exercise can improve lung function and peripheral circulation.

If foot problems limit mobilisation, consider referral to an orthotist or podiatrist. An orthosis (to reduce pressure on an overused area of the foot) or custom-made shoes may relieve pain and prevent worsening of ulcers.