Scleroderma physical examination: Difference between revisions

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{{Scleroderma}}
{{Scleroderma}}


{{CMG}}; {{AE}} {{MKA}}
{{CMG}}; {{AE}} {{MKA}}, {{KS}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with scleroderma usually appear anxious. Physical examination of patients with scleroderma is usually remarkable for [[sclerodactyly]], [[Raynaud's phenomenon]], digital [[ulcers]], [[skin]] [[fibrosis]], and [[Telangiectasis|telangiectasias]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with scleroderma is usually remarkable for [[sclerodactyly]], [[Raynaud's phenomenon]], digital [[ulcers]], [[skin]] [[fibrosis]], and [[telangiectasis]].<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref>
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
*Patients with scleroderma usually appear anxious


===Vital Signs===
===Vital Signs===
 
*Vital signs of patients with scleroderma are usually normal
*High-grade / low-grade fever
*[[Hypertension]] maybe present<ref name="pmid20534372">{{cite journal |vauthors=Khanna D, Denton CP |title=Evidence-based management of rapidly progressing systemic sclerosis |journal=Best Pract Res Clin Rheumatol |volume=24 |issue=3 |pages=387–400 |date=June 2010 |pmid=20534372 |pmc=2884006 |doi=10.1016/j.berh.2009.12.002 |url=}}</ref>
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
*Skin induration<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref>
*[[Skin]] [[induration]]<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref>
*Skin fibrosis
*[[Skin]] [[fibrosis]]<ref name="pmid19487217">{{cite journal |vauthors=Krieg T, Takehara K |title=Skin disease: a cardinal feature of systemic sclerosis |journal=Rheumatology (Oxford) |volume=48 Suppl 3 |issue= |pages=iii14–8 |date=June 2009 |pmid=19487217 |doi=10.1093/rheumatology/kep108 |url=}}</ref><ref name="pmid24442715">{{cite journal |vauthors=Abignano G, Del Galdo F |title=Quantitating skin fibrosis: innovative strategies and their clinical implications |journal=Curr Rheumatol Rep |volume=16 |issue=3 |pages=404 |date=March 2014 |pmid=24442715 |doi=10.1007/s11926-013-0404-5 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref>
*Dilatation of nailfold capillaries
*[[Telangiectasias]]<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref>
*Telangiectasias
*[[Calcinosis]]<ref name="pmid6607734">{{cite journal |vauthors=Steen VD, Ziegler GL, Rodnan GP, Medsger TA |title=Clinical and laboratory associations of anticentromere antibody in patients with progressive systemic sclerosis |journal=Arthritis Rheum. |volume=27 |issue=2 |pages=125–31 |date=February 1984 |pmid=6607734 |doi= |url=}}</ref>
*Calcinosis


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*HEENT examination of patients with scleroderma is usually normal
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*[[Jugular venous distention]] maybe present suggesting [[right heart failure]] due to [[pulmonary hypertension]]
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
*[[Pulmonary]] examination of patients with scleroderma is usually normal
OR
*Inspiratory [[crackles]] upon [[auscultation]] of the [[lung]] are suggestive of [[interstitial lung disease]]<ref name="pmid26324802">{{cite journal |vauthors=Cappelli S, Bellando Randone S, Camiciottoli G, De Paulis A, Guiducci S, Matucci-Cerinic M |title=Interstitial lung disease in systemic sclerosis: where do we stand? |journal=Eur Respir Rev |volume=24 |issue=137 |pages=411–9 |date=September 2015 |pmid=26324802 |doi=10.1183/16000617.00002915 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref>
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
*Right [[ventricular]] [[heave]] can be suggestive of [[Pulmonary arterial hypertension|pulmonary arterial hypertension (PAH)]]
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
*[[Abdominal distention]]<ref name="pmid28133631">{{cite journal |vauthors=Shreiner AB, Murray C, Denton C, Khanna D |title=Gastrointestinal Manifestations of Systemic Sclerosis |journal=J Scleroderma Relat Disord |volume=1 |issue=3 |pages=247–256 |date=2016 |pmid=28133631 |pmc=5267349 |doi=10.5301/jsrd.5000214 |url=}}</ref>
 
OR
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with scleroderma is usually normal
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with scleroderma is usually normal
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*Neuromuscular examination of patients with scleroderma is usually normal
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*[[Myopathy]]<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref>
OR
*[[Ulceration]] of finger tips ([[ischemic]])<ref name="pmid19487217">{{cite journal |vauthors=Krieg T, Takehara K |title=Skin disease: a cardinal feature of systemic sclerosis |journal=Rheumatology (Oxford) |volume=48 Suppl 3 |issue= |pages=iii14–8 |date=June 2009 |pmid=19487217 |doi=10.1093/rheumatology/kep108 |url=}}</ref>
*[[Clubbing]]  
*[[Contractures]] of finger [[flexion]]
*[[Cyanosis]]  
*[[Raynaud's phenomenon]]<ref name="pmid12324557">{{cite journal |vauthors=Wigley FM |title=Clinical practice. Raynaud's Phenomenon |journal=N. Engl. J. Med. |volume=347 |issue=13 |pages=1001–8 |date=September 2002 |pmid=12324557 |doi=10.1056/NEJMcp013013 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref>
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*[[Dilatation]] of nailfold [[capillaries]]<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref>
*Muscle atrophy
*[[Sclerodactyly]]<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref>
*Fasciculations in the upper/lower extremity
 
==Gallery==
===Skin===
<gallery perrow="3">
Image:Progressive systemic sclerosis 001.jpg|Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
 
Image:Progressive systemic sclerosis 002.jpg|Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 003.jpg|Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 004.jpg|Skin: Scleroderma; shoulders & back<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 005.jpg|Skin: Scleroderma in crest syndrome; calcinosis at elbow<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 006.jpg|Hands: Scleroderma<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 007.jpg|Hand: Scleroderma, finger, posterior nail fold<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 008.jpg|Skin: Scleroderma, chest, salt and pepper pigmentation<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 009.jpg|Leg: Morphea, circumscribed scleroderma; age 19<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Progressive systemic sclerosis 010.jpg|Face: Morphea, circumscribed scleroderma<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Systemic sclerosis finger.jpg|Clinical appearance of acrosclerotic piece-meal [[necrosis]] of the thumb in a patient with systemic sclerosis<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:Left Arm Scleroderma Patient .jpg|Left arm of Scleroderma patient, showing skin lesions<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
Image:MercMorphea.JPG|Morphea<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small>
</gallery>
=====Scalp=====
<gallery>
Image:Linear scleroderma10.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Trunk=====
<gallery>
Image:Linear scleroderma01.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Linear scleroderma02.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Extremity=====
<gallery>
 
Image:Linear scleroderma03.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Linear scleroderma04.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Linear scleroderma05.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Linear scleroderma06.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Linear scleroderma07.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
 
Image:Linear scleroderma08.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Linear scleroderma09.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
 
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Latest revision as of 00:06, 30 July 2020

Scleroderma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [14]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [15], Kiran Singh, M.D. [16]

Overview

Patients with scleroderma usually appear anxious. Physical examination of patients with scleroderma is usually remarkable for sclerodactyly, Raynaud's phenomenon, digital ulcers, skin fibrosis, and telangiectasias.

Physical Examination

Physical examination of patients with scleroderma is usually remarkable for sclerodactyly, Raynaud's phenomenon, digital ulcers, skin fibrosis, and telangiectasis.[1][2][3]

Appearance of the Patient

  • Patients with scleroderma usually appear anxious

Vital Signs

  • Vital signs of patients with scleroderma are usually normal
  • Hypertension maybe present[4]

Skin

HEENT

  • HEENT examination of patients with scleroderma is usually normal

Neck

Lungs

Heart

Abdomen

Back

  • Back examination of patients with scleroderma is usually normal

Genitourinary

  • Genitourinary examination of patients with scleroderma is usually normal

Neuromuscular

  • Neuromuscular examination of patients with scleroderma is usually normal

Extremities

Gallery

Skin

  • Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [1]

    Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [1]

  • Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [2]

    Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [2]

  • Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [3]

    Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [3]

  • Skin: Scleroderma; shoulders & back Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [4]

    Skin: Scleroderma; shoulders & back
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [4]

  • Skin: Scleroderma in crest syndrome; calcinosis at elbow Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [5]

    Skin: Scleroderma in crest syndrome; calcinosis at elbow
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [5]

  • Hands: Scleroderma Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [6]

    Hands: Scleroderma
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [6]

  • Hand: Scleroderma, finger, posterior nail fold Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [7]

    Hand: Scleroderma, finger, posterior nail fold
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [7]

  • Skin: Scleroderma, chest, salt and pepper pigmentation Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [8]

    Skin: Scleroderma, chest, salt and pepper pigmentation
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [8]

  • Leg: Morphea, circumscribed scleroderma; age 19 Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [9]

    Leg: Morphea, circumscribed scleroderma; age 19
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [9]

  • Face: Morphea, circumscribed scleroderma Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [10]

    Face: Morphea, circumscribed scleroderma
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [10]

  • Clinical appearance of acrosclerotic piece-meal necrosis of the thumb in a patient with systemic sclerosis Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [11]

    Clinical appearance of acrosclerotic piece-meal necrosis of the thumb in a patient with systemic sclerosis
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [11]

  • Left arm of Scleroderma patient, showing skin lesions Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [12]

    Left arm of Scleroderma patient, showing skin lesions
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [12]

  • Morphea Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [13]

    Morphea
    Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [13]

Scalp
Trunk
Extremity

References

  1. ↑ 1.0 1.1 1.2 1.3 van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE (November 2013). "2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative". Ann. Rheum. Dis. 72 (11): 1747–55. doi:10.1136/annrheumdis-2013-204424. PMID 24092682.
  2. ↑ 2.0 2.1 2.2 2.3 Pope JE, Johnson SR (August 2015). "New Classification Criteria for Systemic Sclerosis (Scleroderma)". Rheum. Dis. Clin. North Am. 41 (3): 383–98. doi:10.1016/j.rdc.2015.04.003. PMID 26210125.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Hudson M, Fritzler MJ, Baron M (May 2010). "Systemic sclerosis: establishing diagnostic criteria". Medicine (Baltimore). 89 (3): 159–65. doi:10.1097/MD.0b013e3181dde28d. PMID 20453602.
  4. ↑ Khanna D, Denton CP (June 2010). "Evidence-based management of rapidly progressing systemic sclerosis". Best Pract Res Clin Rheumatol. 24 (3): 387–400. doi:10.1016/j.berh.2009.12.002. PMC 2884006. PMID 20534372.
  5. ↑ 5.0 5.1 Shah AA, Wigley FM (April 2013). "My approach to the treatment of scleroderma". Mayo Clin. Proc. 88 (4): 377–93. doi:10.1016/j.mayocp.2013.01.018. PMC 3666163. PMID 23541012.
  6. ↑ 6.0 6.1 Krieg T, Takehara K (June 2009). "Skin disease: a cardinal feature of systemic sclerosis". Rheumatology (Oxford). 48 Suppl 3: iii14–8. doi:10.1093/rheumatology/kep108. PMID 19487217.
  7. ↑ Abignano G, Del Galdo F (March 2014). "Quantitating skin fibrosis: innovative strategies and their clinical implications". Curr Rheumatol Rep. 16 (3): 404. doi:10.1007/s11926-013-0404-5. PMID 24442715.
  8. ↑ Steen VD, Ziegler GL, Rodnan GP, Medsger TA (February 1984). "Clinical and laboratory associations of anticentromere antibody in patients with progressive systemic sclerosis". Arthritis Rheum. 27 (2): 125–31. PMID 6607734.
  9. ↑ Cappelli S, Bellando Randone S, Camiciottoli G, De Paulis A, Guiducci S, Matucci-Cerinic M (September 2015). "Interstitial lung disease in systemic sclerosis: where do we stand?". Eur Respir Rev. 24 (137): 411–9. doi:10.1183/16000617.00002915. PMID 26324802.
  10. ↑ Shreiner AB, Murray C, Denton C, Khanna D (2016). "Gastrointestinal Manifestations of Systemic Sclerosis". J Scleroderma Relat Disord. 1 (3): 247–256. doi:10.5301/jsrd.5000214. PMC 5267349. PMID 28133631.
  11. ↑ Wigley FM (September 2002). "Clinical practice. Raynaud's Phenomenon". N. Engl. J. Med. 347 (13): 1001–8. doi:10.1056/NEJMcp013013. PMID 12324557.
  12. ↑ 12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 "Dermatology Atlas".

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