Scleroderma

Scleroderma is in fact a rheumatic and connective tissue disease. It owes its name to the Greek words 'sclero' and 'derma' meaning hard skin. Scleroderma can manifest in many forms. Scleroderma results in thickened and tightened skin and connective tissues at different locations on the body. While scleroderma may be noticed initially on the face and hands, it can appear all over the body. Scleroderma can manifest as localized scleroderma or systemic sclerosis. When scleroderma is localized, it is limited to skin and muscle. The skin affected by scleroderma becomes thickened and tough. In severe cases, scleroderma affects the blood vessels and internal organs. Systemic sclerosis can be fatal. Effects of scleroderma can be mild or serious, depending on the extent of the disease.

Scleroderma occurs when there is overproduction and accumulation of collagen in body tissues. Symptoms of scleroderma include numbness in the hands, cheeks and ears. Raynaud's phenomenon is often one of the first signs of scleroderma. There may be stiffness in the joints of the fingers. The skin becomes itchy and puffy and even the smallest task becomes difficult. Often there is difficulty in swallowing and digestion.

Blood tests of patients afflicted with scleroderma show higher proportion of antibodies produced by the immune system. While there are no medicines to stop collagen from being produced in excess, appropriate medication can reduce or prevent the complications arising from scleroderma. Topical corticosteroids creams can give some relief. Medicines to improve blood circulation may be prescribed. NSAIDs can help alleviate joint pain and stiffness. It is important to check if the digestive and respiratory systems are affected.

Cold Burn

Cold burn or Frostbite occurs when the skin is in touch with an extremely cold body. Extreme cold can cause damage to the skin and underlying tissues. For example, if there is a prolonged contact of the skin with moderately cold body like snow or very cold bodies like dry ice, liquid helium or liquid nitrogen for a brief period, cold burns or ice burns will occur. Here heat is transferred from the skin and organs to the cold body that is in contact. In other kinds of burns, the body that causes the burn is hotter and heat is transferred to the skin or the organ.

Symptoms of frostbite include pins and needles sensation and then numbness in the area. Initially there may be throbbing or aching. The affected part seems to become insensate. In severe frostbite, when the tissue starts to freeze, the skin at that area may appear white and numb. In areas affected by frost burn, abnormal accumulation of blood takes place. In addition to accumulation of body fluids, a blood clot may form thereby preventing blood circulation around the area resulting in tissue decay. Mottled and violaceous tissue is noticed. Normal functioning of the body is disturbed because of cooling of the internal organs, which will lead to a critical condition called hypothermia. Cooling of the brain or heart is very dangerous.

The accumulated plasma in the blister is intended to prevent further damage and also to help in the healing process. To avoid infection from the blister, it is important that it is not punctured as it would expose the raw skin for further infection. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

Severe frostbite may also damage tendons, muscles, nerves and bones. Gangrene is inevitable in the case of very severe frostbite. Frostbite may affect any part of the body.

The most vulnerable parts are hands, feet, nose and ears. Recovery may be significant when the skin and underlying body tissues are injured and it may be permanent if there is injury to the blood vessels. If gangrene follows, the affected part may have to be amputated. When warming up of the affected part begins, the patient will experience intense pain. There will be tingling or burning sensation in the affected area also.

People taking beta-blockers that decrease blood flow to the skin and those who suffer Peripheral Vascular Disease are at risk when exposed to cold for a prolonged period. Any person who is exposed to extreme cold for a long period is susceptible to frostbite. Diabetes, peripheral neuropathy or Raynaud's phenomenon are some conditions that may have increased risk of cold burns. Smoking and windy weather when the rate of heat loss from the skin is more will hinder the healing process. Cold burns at the work place are common. People who work in factories where they may come in contact with metal surfaces that are at extremely cold temperatures are prone to cold burns. When the skin is moist, they may receive almost instantaneous cold burns.

Prevention of freeze burns

Extreme cold, wet clothes, high winds and poor circulation are some of the factors that can contribute to freeze burns. Tight boots or clothing and conditions like cramped positions, some medications, smoking or alcohol can cause frostbite. Wearing appropriate clothing in winter when the temperature goes below normal and will help. Winter clothes like mittens, layered clothing that is wind-proof and water resistant gives good protection.

First Aid for cold burns

It is essential that the ice burn treatment is correctly done as soon as possible.

• If you anticipate prolonged exposure to cold, avoid alcohol or smoking and take sufficient food and rest. Increase physical activity that maintains body temperature and find shelter in a snowstorm as early as possible.
  
  
• Victims should be moved to a warmer place to give shelter from the cold. Constricting jewelry and wet clothes should be removed. If there are symptoms of hypothermia, treat it immediately.
  
  
• Wrap the affected areas using sterile dressings. Dressings should be done after separating affected fingers and toes.
  
  
• In case immediate care is unavailable, you can go for re-warming first aid. This can be done by immersing the affected parts in warm water. Otherwise repeated application of warm clothes to injured ears, cheeks or nose for 20 to 30 minutes helps. Water temperature should be kept between 104 to 108 degrees F. To aid the warming process, the water should be kept circulating. During the warming process, swelling, color changes and severe burning pain may be noticed. The wound will heal when there is a slow heat transfer from water to the affected part.
  
  
• The frost bitten areas should be dressed with dry, sterile dressings. Remembering to keep the fingers or toes separated is important.
  
  
• Thawed areas should not be moved as far as possible.
  
  
• In case of extensive freeze burns, giving warm drinks to the victim helps in replacing lost fluids.
  
  
• Wet clothing must be removed and replaced with warm clothing.
  
  
• Until you reach a warm and safe location, do not go for re-warming process. There is the danger of severe damage because of re-freezing of thawed extremities.
  

Frostnip is the least severe form of cold injury that occurs after the distal extremities are exposed to prolonged period of cold but non-freezing temperatures. Vasoconstriction is felt. Frostnip is a precursor to frostbite and does not involve the same levels of tissue destruction. The affected area appears pale.

Immersion foot is a condition where there is severe tissue injury due to prolonged and persistent exposure to wet conditions, cold or hot. It results in tissue edema and inflammation. This is often seen in homeless persons who are exposed to the elements. The extremities appear swollen and erythematous (skin turning red often manifested in patches). Bad odor is often noticed as also tissue sloughing.

Raynaud's Disease

Raynaud's disease is a condition where the extremities of the body, primarily the fingers and toes experience a reaction to cold. When the symptoms appear without any underlying disease or associated problem, it is a case of primary Raynaud's or Renaud's Disease. But when the condition is due to another disease, it is referred to as Raynaud's syndrome. It is noticed more often among young women and especially people living in very cold climates. This disorder causes the blood vessels supplying blood to the skin to become narrow and thereby limit circulation. The fingers and toes become numb and change color. The skin turns white or blue. There is a prickly stinging pain when the weather warms up and the affected area turns red.

Diagnostic tests for Raynaud's disease include ANA test - a test for presence for antinuclear antibodies that are indicative of an autoimmune disorder. The condition is not serious and there is no cure. If the condition is due to any other underlying disease, it must be investigated. Raynaud's phenomenon can sometimes be indicative of rheumatoid arthritis, lupus or scleroderma. Smokers are at higher risk for Raynaud's disease since nicotine narrows blood vessels.

Medications can alleviate the discomfort. Calcium channel blockers such as nifedipine and amlodipine are prescribed to dilate the small blood vessels in the limbs. Creams containing vasodilators can be applied to soothe skin ulcers. It is essential to keep the hands and feet well protected with warm clothing during cold climate. Lotions and moisturizers are used to keep the fingertips moist.