Pharmacological therapy for cutaneous features of systemic sclerosis

In the early (scleroedematous) stage, oral antihistamines can be used for pruritus. Occasionally topical corticosteroids may offer some symptomatic relief for skin symptoms. Rarely, low-dose systemic corticosteroids may be trialled, but avoid doses of more than 10 mg daily because there is a risk of precipitating scleroderma renal crisis (accelerated hypertension and acute kidney failure).

For severe symptoms, or in the longer term, immunomodulatory drugs used by specialists may include oral cyclophosphamide, mycophenolate and methotrexate. The evidence for these drugs varies. Mycophenolate has been beneficial in case seriesMendoza, 2012. Methotrexate is used in practice despite limited evidence to support its usevan den Hoogen, 1996Pope, 2001.