Localized skin tightening

Introduction Local skin tightens, most commonly in scleroderma. Scleroderma is also known as systemic sclerosis. As the name implies, it is a disease in which the skin becomes hard. Skin changes are a hallmark of systemic sclerosis. However, the degree of lesions varies greatly. The mild ones only have localized skin sclerosis and calcification. In severe cases, extensive skin hardening and thickening may occur throughout the body. Typical skin lesions in turn undergo three stages of swelling, infiltration, and atrophy. The lesions are symmetrical, and the lesions are gradually extended from the fingers to the proximal end, and the boundary between the lesioned skin and the normal skin is unclear.

Cause

The etiology and pathogenesis of the disease are unknown and may be related to the following factors:

1. Genetics: In patients with scleroderma, the expression of certain HLA-II antigens is significantly higher than that of normal people.

2, academic products and drugs: such as polyvinyl chloride, organic solvents, silicon, silica, epoxy resin, L-tryptophan, bleomycin, pentazocine can induce hard skin and visceral fibrosis.

3, immune abnormalities: the disease has humoral immunity and cellular immune abnormalities, specific anti-Scl-70 autoantibodies can be found in the patient's serum. This indicates that the occurrence of this disease is closely related to immune disorders.

4, connective tissue metabolism abnormalities: the characteristic change of this disease is excessive collagen production, collagen content in the skin increased significantly.

5, the role of cytokines: some cytokines involved in the pathogenesis of this disease, such as transforming growth factor, epidermal growth factor, platelet-derived growth factor.

6, vascular abnormalities: most patients with scleroderma showed Raynaud's phenomenon, pathology showed small arteries and microvascular intima thickening, stenosis or occlusion.

Localized scleroderma can be diagnosed based on typical skin changes.

an examination

Related inspection

Skin elasticity check physical examination of skin color skin disease

Systemic sclerosis: American College of Rheumatology (ARA) 1998 standard:

A main standard: the hard skin changes in the proximal part of the metacarpophalangeal joint, which can affect the entire limb, face, body and dry.

B secondary criteria: 1 finger scleroderma: The above skin changes are limited to the fingers.

2 The tip of the finger has a concave scar and the finger pad disappears.

3 double lung basal fibrosis.

Any major criteria or 2 secondary criteria can be diagnosed, other manifestations that are helpful for diagnosis: Raynaud's phenomenon, polyarthritis or joint pain, abnormal esophageal motility, skin pathology collagen fiber swelling and fibrosis, immunological examination ANA , anti-Scl-70 antibody, and centromere antibody (ACA) positive.

CREST syndrome, specifically 3 of which 5 symptoms, or more than 3 plus dot antibody can be diagnosed.

Differential diagnosis

(1) Localized scleroderma needs to be identified with the following diseases.

1. Spot atrophy: Early damage is of different sizes, skin-colored or blue-white, dimples or bulges, wrinkles on the surface, and hard to touch.

2. Atrophic sclerosing moss: The skin lesions are lavender-colored flat papules, which vary in size and often aggregate, but do not fuse with each other. There are hair follicle horny plugs on the surface, sometimes blisters, and skin atrophy gradually occurs.

(B) Systemic sclerosis needs to be identified with the following diseases.

1. Adult scleredema: The skin lesions start from the head and neck to the shoulder and back, and the deep dermis is swollen and stiff. Local non-pigmentation, no atrophy and hair loss, and self-healing tendency.

2. Mixed connective tissue disease: The patient has mixed manifestations of systemic lupus erythematosus, scleroderma, dermatomyositis or polymyositis, including Raynaud's phenomenon, non-recessed edema of face and hands, and swollen fingers. , fever, non-destructive polyarthritis, muscle weakness or myalgia and other symptoms. Both leaching nuclear antigen (ENA) and RNP antibodies are highly titer positive.

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