Aktuelle Rheumatologie 2022; 47(04): 290-302
DOI: 10.1055/a-1887-5399
Übersichtsarbeit

Sklerodermie – „die harte Haut“

Scleroderma: “the hard skin”
Jil Speidel
1   Uniklinik Köln, Klinik und Poliklinik für Dermatologie und Venerologie, Köln
,
Nicolas Hunzelmann
1   Uniklinik Köln, Klinik und Poliklinik für Dermatologie und Venerologie, Köln
,
Pia Moinzadeh
1   Uniklinik Köln, Klinik und Poliklinik für Dermatologie und Venerologie, Köln
› Institutsangaben

Zusammenfassung

Unter dem Begriff Sklerodermie ist eine heterogene Gruppe von Erkrankungen zusammengefasst, die eine kutane Sklerose gemeinsam haben. Die einzelnen Erkrankungen variieren in der Beteiligung betroffener Strukturen wie Haut, Fettgewebe, Muskulatur, Gelenkstrukturen, Knochen, innerer Organe und der damit einhergehenden Krankheitsausprägung. Es lassen sich grundsätzlich zwei verschiedene Subtypen unterscheiden: die lokalisierte Sklerodermie (LoS) und die systemische Sklerose (SSc), die sich jeweils in weitere Subgruppen unterteilen lassen. Es handelt sich um zwei verschiedene Erkrankungen, die sich in der Ausprägung der Hautsklerosierung, der Beteiligung innerer Organe, im Antikörper-Profil, im Krankheitsmanagement sowie der Prognose unterscheiden. Darüber hinaus gibt es Krankheitsbilder, die eine Sklerodermie imitieren und daher als sklerodermie-artige Erkrankungen oder auch als Pseudosklerodermien bezeichnet werden. Um die richtige Diagnose stellen zu können, ist ein standardisiertes diagnostisches Vorgehen bedeutsam. Die frühe Diagnosestellung ist wichtig, um frühzeitige eine Therapie einleiten zu können, und so funktionelle kutane und extrakutane Einschränkungen und auch kosmetische Schäden gering halten zu können.

Abstract

The term scleroderma covers a heterogeneous group of diseases sharing the characteristic feature of cutaneous sclerosis. The individual diseases vary in the involvement of affected structures such as skin, adipose tissue, muscles, joint structures, bones, internal organs and the associated disease expression. Basically, two different subtypes can be distinguished: localised scleroderma (LoS) and systemic sclerosis (SSc), each of which are subdivided into further subgroups. These are two distinct diseases that differ in the extent of skin sclerosis, involvement of internal organs, antibody profile, disease management and prognosis. In addition, there are clinical pictures that mimic scleroderma and are therefore referred to as scleroderma-like diseases or pseudoscleroderma. In order to make the correct diagnosis, a standardised diagnostic procedure is significant. Early diagnosis is important in order to initiate early treatment and thus minimise functional cutaneous and extracutaneous impairment as well as cosmetic damage.



Publikationsverlauf

Artikel online veröffentlicht:
11. August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Ferreli C, Gasparini G, Parodi A. et al. Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 53: 306-336
  • 2 Hawk A, English JC. Localized and systemic scleroderma. Semin Cutan Med Surg 2001; 20: 27-37
  • 3 Knobler R, Moinzadeh P, Hunzelmann N. et al. European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes. J Eur Acad Dermatol Venereol 2017; 31: 1401-1424
  • 4 Giuggioli D, Colaci M, Cocchiara E. et al. Erratum to “From Localized Scleroderma to Systemic Sclerosis: Coexistence or Possible Evolution”. Dermatol Res Pract 2018; 2018: 6984282
  • 5 Fett N, Werth VP. Update on morphea: part I. Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol 2011; 64: 217-228 quiz 229-30
  • 6 Hunzelmann N, Genth E, Krieg T. et al. The registry of the German Network for Systemic Scleroderma: frequency of disease subsets and patterns of organ involvement. Rheumatology (Oxford) 2008; 47: 1185-1192
  • 7 Plewig G, Ruzicka T, Kaufmann R. et al. Braun-Falco’s Dermatologie, Venerologie und Allergologie. Berlin, Heidelberg: Springer Berlin Heidelberg; 2018
  • 8 Moinzadeh P, Kreuter A, Krieg T. et al. Morphea or localized scleroderma and extragenital lichen sclerosus. Hautarzt 2018; 69: 892-900
  • 9 Kreuter A, Krieg T, Worm M. et al. AWMF Guideline no. 013/066. Diagnosis and therapy of circumscribed scleroderma. J Dtsch Dermatol Ges 2009; 7: S1-S14
  • 10 Kreuter A, Krieg T, Worm M. et al. German guidelines for the diagnosis and therapy of localized scleroderma. J Dtsch Dermatol Ges 2016; 14: 199-216
  • 11 Christen-Zaech S, Hakim MD, Afsar FS. et al. Pediatric morphea (localized scleroderma): review of 136 patients. J Am Acad Dermatol 2008; 59: 385-396
  • 12 Avancini J, Valente NYS, Romiti R. Generalized lenticular atrophoderma of Pasini and Pierini. Pediatr Dermatol 2015; 32: 389-391
  • 13 Zulian F, Athreya BH, Laxer R. et al. Juvenile localized scleroderma: clinical and epidemiological features in 750 children. An international study. Rheumatology (Oxford) 2006; 45: 614-620
  • 14 Leitenberger JJ, Cayce RL, Haley RW. et al. Distinct autoimmune syndromes in morphea: a review of 245 adult and pediatric cases. Arch Dermatol 2009; 145: 545-550
  • 15 Marzano AV, Menni S, Parodi A. et al. Localized scleroderma in adults and children. Clinical and laboratory investigations on 239 cases. Eur J Dermatol 2003; 13: 171-176
  • 16 Herrick AL, Ennis H, Bhushan M. et al. Incidence of childhood linear scleroderma and systemic sclerosis in the UK and Ireland. Arthritis Care Res (Hoboken) 2010; 62: 213-218
  • 17 Chiang K-L, Chang K-P, Wong T-T. et al. Linear scleroderma “en coup de sabre”: initial presentation as intractable partial seizures in a child. Pediatr Neonatol 2009; 50: 294-298
  • 18 Tollefson MM, Witman PM. En coup de sabre morphea and Parry-Romberg syndrome: a retrospective review of 54 patients. J Am Acad Dermatol 2007; 56: 257-263
  • 19 Orozco-Covarrubias L, Guzmán-Meza A, Ridaura-Sanz C. et al. Scleroderma ‘en coup de sabre’ and progressive facial hemiatrophy. Is it possible to differentiate them?. J Eur Acad Dermatol Venereol 2002; 16: 361-366
  • 20 Jappe U, Hölzle E, Ring J. Parry-Romberg syndrome. Summary and new knowledge based on an unusual case. Hautarzt. 1996; 47: 599-603
  • 21 Lehman TJ. The Parry Romberg syndrome of progressive facial hemiatrophy and linear scleroderma en coup de sabre. Mistaken diagnosis or overlapping conditions?. J Rheumatol 1992; 19: 844-845
  • 22 Bielsa I, Ariza A. Deep morphea. Semin Cutan Med Surg 2007; 26: 90-95
  • 23 Blaszczyk M, Krysicka-Janiger K, Jabłońska S. Primary atrophic profound linear scleroderma. Report of three cases. Dermatology 2000; 200: 63-66
  • 24 Malandrini A, Dotti MT, Federico A. Selective ipsilateral neuromuscular involvement in a case of facial and somatic hemiatrophy. Muscle Nerve 1997; 20: 890-892
  • 25 Lebeaux D, Sène D. Eosinophilic fasciitis (Shulman disease. Best Pract Res Clin Rheumatol 2012; 26: 449-458
  • 26 Laxer RM, Zulian F. Localized scleroderma. Curr Opin Rheumatol 2006; 18: 606-613
  • 27 Weibel L, Harper JI. Linear morphoea follows Blaschko’s lines. Br J Dermatol 2008; 159: 175-181
  • 28 Arkachaisri T, Vilaiyuk S, Li S. et al. The localized scleroderma skin severity index and physician global assessment of disease activity: a work in progress toward development of localized scleroderma outcome measures. J Rheumatol 2009; 36: 2819-2829
  • 29 Arkachaisri T, Vilaiyuk S, Torok KS. et al. Development and initial validation of the localized scleroderma skin damage index and physician global assessment of disease damage: a proof-of-concept study. Rheumatology (Oxford) 2010; 49: 373-381
  • 30 Krieg T, Takehara K.. Skin disease: a cardinal feature of systemic sclerosis. Rheumatology (Oxford) 2009; 48iii14-8
  • 31 Sato S, Fujimoto M, Kikuchi K. et al. Soluble CD4 and CD8 in serum from patients with localized scleroderma. Arch Dermatol Res 1996; 288: 358-362
  • 32 Kreuter A, Hyun J, Stücker M. et al. A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma. J Am Acad Dermatol 2006; 54: 440-447
  • 33 Marrani E, Foeldvari I, Lopez JA. et al. Comparing ultraviolet light A photo(chemo)therapy with Methotrexate protocol in childhood localized scleroderma: Evidence from systematic review and meta-analysis approach. Semin Arthritis Rheum 2018; 48: 495-503
  • 34 Weibel L, Sampaio MC, Visentin MT. et al. Evaluation of methotrexate and corticosteroids for the treatment of localized scleroderma (morphoea) in children. Br J Dermatol 2006; 155: 1013-1020
  • 35 Fett N, Werth VP. Update on morphea: part II. Outcome measures and treatment. J Am Acad Dermatol 2011; 64: 231-242 quiz 243-4
  • 36 Fett NM. Morphea: evidence-based recommendations for treatment. Indian J Dermatol Venereol Leprol 2012; 78: 135-141
  • 37 van den Hoogen F, Khanna D, Fransen J. et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72: 1747-1755
  • 38 LeRoy EC, Black C, Fleischmajer R. et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988; 15: 202-205
  • 39 Bellando-Randone S, Guiducci S, Matucci-Cerinic M. Very early diagnosis of systemic sclerosis. Pol Arch Med Wewn 2012; 122: 18-23
  • 40 Sticherling M. Systemic sclerosis-dermatological aspects. Part 1: Pathogenesis, epidemiology, clinical findings. J Dtsch Dermatol Ges 2012; 10: 705-718 quiz 716
  • 41 Pearson DR, Werth VP, Pappas-Taffer L. Systemic sclerosis: Current concepts of skin and systemic manifestations. Clin Dermatol 2018; 36: 459-474
  • 42 Alivernini S, De Santis M, Tolusso B. et al. Skin ulcers in systemic sclerosis: determinants of presence and predictive factors of healing. J Am Acad Dermatol 2009; 60: 426-435
  • 43 Nihtyanova SI, Brough GM, Black CM. et al. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis 2008; 67: 120-123
  • 44 Herrick AL. The pathogenesis, diagnosis and treatment of Raynaud phenomenon. Nat Rev Rheumatol 2012; 8: 469-479
  • 45 Pakozdi A, Nihtyanova S, Moinzadeh P. et al. Clinical and serological hallmarks of systemic sclerosis overlap syndromes. J Rheumatol 2011; 38: 2406-2409
  • 46 Kucharz EJ, Kopeć-Mędrek M. Systemic sclerosis sine scleroderma. Adv Clin Exp Med 2017; 26: 875-880
  • 47 Smith V, Herrick AL, Ingegnoli F. et al. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Autoimmunity Reviews 2020; 19: 102458
  • 48 Mierau R, Moinzadeh P, Riemekasten G. et al. Frequency of disease-associated and other nuclear autoantibodies in patients of the German Network for Systemic Scleroderma: correlation with characteristic clinical features. Arthritis Res Ther 2011; 13: R172
  • 49 Trang G, Steele R, Baron M. et al. Corticosteroids and the risk of scleroderma renal crisis: a systematic review. Rheumatol Int 2012; 32: 645-653
  • 50 Ebata S, Yoshizaki A, Oba K. et al. Safety and efficacy of rituximab in systemic sclerosis (DESIRES): a double-blind, investigator-initiated, randomised, placebo-controlled trial. The Lancet Rheumatology 2021; 3: e489-e497
  • 51 Tashkin DP, Roth MD, Clements PJ. et al. Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): a randomised controlled, double-blind, parallel group trial. Lancet Respir Med 2016; 4: 708-719
  • 52 Pope JE, Bellamy N, Seibold JR. et al. A randomized, controlled trial of methotrexate versus placebo in early diffuse scleroderma. Arthritis Rheum 2001; 44: 1351-1358
  • 53 van den Hoogen FH, Boerbooms AM, Swaak AJ. et al. Comparison of methotrexate with placebo in the treatment of systemic sclerosis: a 24 week randomized double-blind trial, followed by a 24 week observational trial. Br J Rheumatol 1996; 35: 364-372
  • 54 Kowal-Bielecka O, Fransen J, Avouac J. et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis 2017; 76: 1327-1339
  • 55 Denton CP, Hughes M, Gak N. et al. BSR and BHPR guideline for the treatment of systemic sclerosis. Rheumatology (Oxford) 2016; 55: 1906-1910
  • 56 Fabri M, Hunzelmann N. Differentialdiagnose der Sklerodermien und Pseudosklerodermien. J Dtsch Dermatol Ges 2007; 5
  • 57 Distler O, MD., B. Highland K., et al. Nintedanib for systemic sclerosis – associated interstitial lung disease. N Engl J Med 2019; 380: 2518-2528
  • 58 Khanna, DineshLucero, Eleonora et al. Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Respiratory Medicine 8: 963-974