Scleroderma

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Abstract
Scleroderma presents a formidable therapeutic challenge for both the physician and the patient. Over the years many medications and interventions have been reported to be beneficial in scleroderma. With equal regularity, however, when put to the test of the randomized controlled trial, many of these same medications have subsequently been shown to be ineffective. This is true for both the localized and systemic forms of the disease. Two of the most recent additions to this inauspicious list for systemic sclerosis include D-penicillamine and methotrexate. At the very least these outcomes should point to our deficiencies in understanding the pathogenesis of this unusual disorder. It should raise the possibility that collagen and inflammatory or immune cells are not good therapeutic targets and new targets should be sought. Despite the scope of these problems and the lack of definitive therapy, there is a great deal an individual physician can do to help a patient living with scleroderma. This article presents management approaches to patients with either localized or systemic scleroderma.