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When Your Client Has Scleroderma—What Every Esthetician Should Know

By: Patricia Baker
Posted: July 30, 2013, from the August 2013 issue of Skin Inc. magazine.

Sharon Monsky, founder of the Scleroderma Research Foundation, died from the disease in 2002. All photos courtesy of the Scleroderma Research Foundation, San Francisco.

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Heidi Jacobe, MD, Dallas. Jacobe is a dermatologist who specializes in connective tissue disease, and is an associate professor at the University of Texas Medical Center in Dallas. She explains, “Scleroderma is a complex genetic disease in which patients have an excessive buildup of collagen in the dermis. Although their skin appears to be thickened, it is really dry and fragile, and may not heal well.” Jacobe recommends that estheticians employ nonirritating, deeply hydrating treatments for their scleroderma clients. If there is any concern about a service, treat a small area first and watch for any adverse reactions.

Jacobe cautions that tattoos, especially permanent makeup, should not be administered on scleroderma clients. Changes to the skin as the disease progresses can include severe distortion of the facial features and the hands, and will adversely impact the original tattooed area. Both Jacobe and Hunter say clients can have noncollagen-based fillers and Botox, although it is often not needed, because the skin-tightening that occurs due to the disease often gets rid of small wrinkles.

Jacobe adds that there is a localized form of scleroderma called morphea, which is not as severe or life-threatening. With morphea, there is no internal organ involvement, but it can produce hardening of the skin and hyperpigmented areas. The skin pigmentation as a result of morphea is so deep that it is difficult to bleach effectively. Intense pulsed light (IPL) is currently being used with some success. Estheticians need to be aware that scleroderma skin—whether the scleroderma is systemic or localized—is different skin. If there are any concerns about the products or technology you are using, always try a small area first and then evaluate further treatment.

Robert Simms, MD, Boston. Simms is chief of rheumatology at Boston University School of Medicine. His major research interest is in scleroderma clinical outcome measures and clinical trials. Simms concurs that moisturizing scleroderma skin is important in a spa setting, but points out that there is no topical treatment that will stop the progression of this chronic disease. In fact, there are components of the disease that researchers are finding have more of a neural rather than a dermatological component, such as the overall itching sensation described by Mary.

Fillers may also be advised for scleroderma patients as the skin tightens and purses uncomfortably around the mouth, creating deformity. “Technology that increases collagen is not necessarily a bad thing, either,” says Simms. “However, the jury is out and there is no real data yet on any of these treatments for scleroderma patients.” Proceed with caution, and test on just a small area before treating the entire face, neck and hands.

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