Scleroderma physical examination

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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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