Systemic sclerosis presents its cutaneous manifestations with innovative triple therapeutic regime

Abstract

Objective To record and evaluate the different cutaneous manifestations of all patients with an established diagnosis of systemic sclerosis and to have a new therapeutic trial.   Methods This is a cross-sectional descriptive clinical study with a therapeutic trial that was conducted during the period from 2014 to 2023. All patients with a well-established diagnosis of systemic sclerosis were evaluated for various skin manifestations. A triple therapeutic trial was carried out using oral zinc sulfate, sildenafil, and prednisolone.   Results The main early presenting symptoms were the sensation of coldness usually cold hands and feet seen in 25 (100%) cases, followed by dusky blue red hands and feet observed in 23(92%) cases, followed by difficult hands movement and stiffness together with loss of facial expression in 21 (84%) of patients. Later on, patients mentioned hardening of the face and hands skin with the enhanced shininess of the face. Also pitting scarring of pulps and tips of fingers and sometimes toes could be considered as early symptoms of the disease, seen in 25 (100%) of patients. While the most striking findings on examination were shiny hardening of skin which was most prominent on the face and hands. Difficulty in opening the mouth and protruding the tongue was also a common finding that was detected in 19 (76%) cases. Angiomatous macules and papules of the face were rarely seen as observed only in 3 (12%) female patients. Pitting the pulps and tips of fingers were very early striking findings and very helpful diagnostic signs for diagnosis. Calcinosis cutis commonly affecting elbows were observed as late findings that commonly associated with necrosis of tissue and infections and only observed in 2 (8%) cases.   Conclusion Systemic sclerosis usually manifests in cold weather and patients complain of coldness especially on hands and feet with hardening of the skin. Pitting and scarring of the tips of fingers are significant diagnostic findings that are often followed by ischemic changes. While facial angiomatous macules and papules, calcinosis cutis, and rippling pigmentation with leukoderma were detected lately. Triple therapy showed its effectiveness in improving the complaints of patients.