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Scleroderma (Systemic Sclerosis)

Scleroderma means “hard skin.” It is an autoimmune condition in which the body makes too much scar-like collagen, causing tight, thick skin. Localized scleroderma (morphea) stays in the skin and tissues just beneath it; systemic sclerosis can also reach blood vessels, the gut, lungs, heart and kidneys. There is no cure, but many problems can be managed, and checking the organs regularly matters. A sudden jump in blood pressure, fingertip sores, breathlessness or trouble swallowing need prompt medical care.

Call 911 or go to an emergency room right away if you have scleroderma (or a diagnosis is being investigated) and any of these happen:

  • A sudden, new rise in blood pressure — especially with a new severe headache, shortness of breath or chest discomfort. This can be a scleroderma renal crisis, a life-threatening complication marked by very high blood pressure and sudden kidney injury. Its symptoms are often non-specific (shortness of breath, chest discomfort, headache), and about 1 in 10 people are not high on blood pressure when it starts, so do not wait for a high reading (Ng et al., 2026). Risk factors include diffuse and rapidly progressive skin thickening, palpable tendon “friction rubs,” and new anemia or heart events (Montrief et al., 2019). Blood-pressure medicines called ACE inhibitors have drastically improved survival, but a 2026 editorial still reports a 1-year death rate of 36%, with a quarter of patients remaining on dialysis (Ng et al., 2026). Tell the emergency team you have scleroderma.
  • A fingertip or toe sore that is getting worse, turns black, looks infected or hurts severely. Arthritis UK lists open sores over the fingertips, caused by poor blood supply, among the skin changes of systemic sclerosis (Arthritis UK). MBHA suggests same-day care for a black or blue finger or toe, spreading redness, pus or severe pain.
  • Severe shortness of breath, or chest pain. Lung scarring and high blood pressure in the lungs’ arteries are serious problems systemic sclerosis can cause (Arthritis UK). MBHA suggests treating sudden or severe breathlessness or chest pain as an emergency.
  • Trouble swallowing together with weight loss, food that sticks, or repeated vomiting. Swallowing problems and heartburn are common (Arthritis UK), the NHS lists weight loss as a symptom of the diffuse form (NHS), and fluid loss from the gut and poor appetite can cause sudden kidney injury (Ng et al., 2026). MBHA suggests telling your doctor promptly if eating and drinking have become hard.

Do not wait for a chiropractic, acupuncture or massage appointment, and do not try an herb or supplement first, if you have any of these signs. Do not start, raise or stop a steroid medicine on your own — see the steroid caution below.

What is scleroderma?

Scleroderma means “hard skin.” It is an autoimmune disease that causes inflammation and thickening in the skin and other areas of the body (MedlinePlus). The NHS describes an overactive immune system leading cells in the connective tissue to make too much collagen, causing scarring and thickening (fibrosis). It is not clear why; certain genes are thought to be involved (NHS). MedlinePlus adds that scleroderma is not passed from parent to child, though you are more likely to get it if a close relative has it, and that a trigger cannot be found for most people (MedlinePlus). It is more common in women, usually appears between ages 30 and 50, and is more common, and can be more severe, in African Americans (MedlinePlus). There is no cure, but symptoms can be managed and treatment can help limit damage (NHS, MedlinePlus).

Localized versus systemic

The two main types differ a great deal, so ask your doctor which one you have.

  • Localized scleroderma (morphea) mostly affects the skin, sometimes with muscle and bone beneath it. In plaque morphea, most common in adults, discolored oval patches may improve after a few years; in linear morphea, thickened skin runs in lines, mostly along the arms and legs of children, and can cause permanent problems such as shortened limbs (NHS). A Cochrane review of 14 small trials (429 people) found only low-quality evidence on treatment, with some sign that methotrexate plus a steroid may help children with active disease (Albuquerque et al., 2019).
  • Systemic sclerosis can affect blood vessels and internal organs as well as the skin. Limited cutaneous disease usually affects the skin of the hands, lower arms, feet, lower legs and face, often starts with Raynaud’s and is generally milder; in diffuse disease, skin changes can affect the whole body and the internal organs are more likely to be involved (NHS, Arthritis UK). Children are rarely affected (NHS). The rest of this guide is mostly about systemic sclerosis.

What does systemic sclerosis look and feel like?

Symptoms differ from person to person. Arthritis UK describes these common patterns (Arthritis UK):

  • Raynaud’s phenomenon — fingers or toes turn white, then blue, in the cold or with stress. Many people have Raynaud’s without systemic sclerosis, but most people with systemic sclerosis have it at some point, often as the first sign. See our Raynaud’s guide.
  • Skin changes — thickening and hardening of the skin of the hands, arms and face; morning swelling of the hands and feet; shiny skin; a stiff face that makes it hard to open the mouth wide; small red spots. Later, or less often: open sores over the fingertips and chalky white lumps of calcium under the skin.
  • Digestive problems — weak swallowing muscles and heartburn are common; less often there is bloating, diarrhea or constipation.
  • Joint and muscle stiffness or pain, sometimes muscle weakness; tight skin can pull joints into a bent position over time.
  • Serious organ problems, less commonly: scarring of the lungs, high blood pressure in the lungs that can strain the heart, and kidney problems with high blood pressure.

MedlinePlus adds fatigue, notes that most people with systemic scleroderma have some loss of lung function, and says dry mouth and damage to mouth tissues can speed up tooth decay (MedlinePlus). About 1 in 5 people with systemic sclerosis also have another condition such as lupus, Sjögren’s disease or inflammatory arthritis (Arthritis UK); see our lupus and Sjögren’s guides, and for muscle inflammation our dermatomyositis guide.

Diagnosis, monitoring and outlook

There is no single test. Your provider asks about symptoms and history, examines you, and may order blood tests (including an ANA test), a skin biopsy and imaging to check for organ damage (MedlinePlus). Arthritis UK also lists breathing tests, an echocardiogram (heart ultrasound), stomach tests such as endoscopy, and capillaroscopy (looking at the tiny blood vessels at the nail fold) (Arthritis UK). Many people see a rheumatologist, and sometimes other specialists if organs are involved (MedlinePlus).

Because serious internal problems can develop quietly, doctors check the organs even when you feel well. Arthritis UK recommends regular check-ups, preferably once a year (Arthritis UK), and the NHS says to expect regular blood-pressure checks and other organ tests (NHS). Renal crisis usually occurs within four years of diagnosis, though about a quarter of cases begin later (Ng et al., 2026).

The course varies. Arthritis UK says most people find that systemic sclerosis affects just a few parts of the body and comes on gradually; it may slowly worsen but usually settles after a few years, although it can progress faster, and the body can repair some extra scar tissue once the disease is less active (Arthritis UK). The NHS is more cautious: some types may improve on their own, while others can lead to severe and life-threatening problems (NHS). The ACR emphasizes that many people with scleroderma lead long, fulfilling lives (ACR).

When to see a provider (not an emergency): see your doctor if you notice thick, tight or shiny skin, new finger or toe color changes in the cold, puffy fingers, trouble swallowing, persistent heartburn, a dry cough or new breathlessness.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Work with a rheumatologist (and other specialists as needed) to classify the type, treat Raynaud’s and fingertip ulcers, protect the gut, lungs, heart and kidneys with regular monitoring, and use immune-calming medicines in selected cases. Physical and occupational therapy, skin care and quitting smoking are part of the plan. Cost estimate being researched. Medicare Part B covers medically necessary outpatient physical and occupational therapy, with 20% coinsurance after the deductible. There is no cure, but many problems can be managed. Blood-pressure medicines (ACE inhibitors) transformed outcomes in renal crisis. For lung scarring, trials show modest benefits from several medicines. Evidence for skin thickening is thinner.
Chiropractic No chiropractic treatment is established for scleroderma itself. A chiropractor can help most by recognizing warning signs and referring you, and by helping with an unrelated back or neck problem if you have one. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation (20% coinsurance after the deductible). We found little research on chiropractic care for scleroderma. It should never delay evaluation of a blood-pressure spike, fingertip sores or breathlessness.
Acupuncture A course of needle treatments, alongside (never instead of) medical care, sometimes tried for Raynaud’s, pain or gut symptoms. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain, so scleroderma is not covered. Evidence is limited to small studies and case reports. A review of acupuncture for Raynaud’s rated its evidence very low quality, and a sham-controlled trial in secondary Raynaud’s found no significant effect.
Herbal medicine No herb or supplement has been proven to treat scleroderma. Many people use them anyway; check with your doctor and pharmacist first. Cost estimate being researched. Surveys show herbal use is common, but studies of effectiveness are insufficient. Supplements can interact with medicines, and St. John’s wort, which some patients use, makes many medicines less effective.
Massage therapy Hands-on work for comfort, relaxation and stiff hands, adapted to fragile skin. Specialist manual lymph drainage has been studied for swollen hands. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. Medicare doesn’t cover massage therapy. A small study found manual lymph drainage reduced hand swelling and improved hand function in the early swollen phase. General massage has little direct research for scleroderma, and it is not a treatment for the disease.
MBHA Wellness Coach Warmth planning, a daily skin, hand and mouth routine, meal pacing for reflux and swallowing, a quit-smoking plan, stress skills, appointment and symptom tracking, and help preparing questions for your care team. Cost estimate being researched. Supports — never replaces — medical care. Exercise, education, keeping warm and not smoking are recommended by the sources we read.

Approach 1 of 6

Conventional medicine (AMA)

Care for systemic sclerosis is organized around the parts of the body that are affected. The NHS lists the aims as relieving symptoms, preventing the condition getting worse, detecting and treating complications such as pulmonary hypertension, and helping you keep using the affected parts of the body (NHS). A European expert task force (EULAR) published treatment recommendations in 2017 covering Raynaud’s, digital ulcers, pulmonary arterial hypertension, skin and lung disease, renal crisis and gut involvement (Kowal-Bielecka et al., 2017). Medicines below are named by class only; we do not list doses.

1. Raynaud’s and fingertip ulcers

The ACR says calcium channel blockers (blood-pressure medicines) and PDE-5 inhibitors can improve circulation (ACR); the EULAR task force also recommends PDE-5 inhibitors for Raynaud’s and ulcers, and fluoxetine, an antidepressant, for scleroderma-related Raynaud’s (Kowal-Bielecka et al., 2017). A Cochrane review of 38 trials found moderate-quality evidence that calcium channel blockers reduce attacks, though the reduction in severity was small and they seemed to work better in primary than in secondary Raynaud’s (the kind that accompanies scleroderma); common side effects were headache, dizziness, nausea, palpitations and ankle swelling (Rirash et al., 2017). For painful ulcers that will not heal, Arthritis UK says a drug such as iloprost can be given by infusion in hospital (Arthritis UK). A 2023 systematic review found that intravenous iloprost, PDE-5 inhibitors and a statin were effective for active ulcers, that bosentan reduced the rate of future ulcers, and that no data supported immune-suppressing or anti-platelet medicines for ulcers; the authors noted the evidence is relatively low quality (Ross et al., 2023). See our Raynaud’s guide for self-care.

2. Skin thickening and the immune system

The ACR says there are no approved medications specifically for skin thickening, but methotrexate and mycophenolate can be used early in the disease depending on other features such as joint, muscle or lung involvement (ACR). Arthritis UK lists conventional immune-suppressing medicines (methotrexate, ciclosporin, cyclophosphamide, mycophenolate, azathioprine) for more severe cases, and says the biologic rituximab is sometimes used for severe disease (Arthritis UK). In a 2020 trial of the biologic tocilizumab in early diffuse disease, the main skin endpoint was not met (Khanna et al., 2020). For selected people with rapidly progressive disease, stem cell transplantation can be considered (Kowal-Bielecka et al., 2017, ACR); a 2022 Cochrane review of three small trials found moderate-certainty evidence that it improved event-free survival and skin thickness compared with cyclophosphamide, but caused more serious side effects, including a high risk of early treatment-related death (Bruera et al., 2022).

3. Steroids — a special caution

Arthritis UK says steroid tablets can be used early, when skin is puffy, or later for muscle or lung problems, but are usually given in low doses because high doses can raise blood pressure and increase the risk of kidney problems (Arthritis UK). In a case-control study of 110 people who developed renal crisis, high-dose steroid use in the previous six months was more common than in matched people without a crisis (36% versus 12%), while new low-dose use and continuing use of any steroid dose were not associated with a higher risk (Steen & Medsger, 1998). An Italian series of 410 people found risk rose with each additional milligram of daily prednisone, though the authors called the effect weak (Montanelli et al., 2013), and a 2026 editorial lists recent higher-dose steroid use as a precipitating factor (Ng et al., 2026). If you take a steroid, ask your rheumatologist how your blood pressure and kidneys will be watched, and do not change the dose yourself.

4. Lung disease

Interstitial lung disease (scarring of the lung tissue) is common in systemic sclerosis and a leading cause of death related to it (Distler et al., 2019). The ACR describes mycophenolate as used for lung scarring or inflammation, tocilizumab in more severe cases, and nintedanib or rituximab for progressive disease (ACR). What the trials found:

  • Cyclophosphamide: in 158 people, one year of oral treatment had a significant but modest benefit on lung function, breathlessness and quality of life, with more adverse events than placebo (Tashkin et al., 2006).
  • Mycophenolate versus cyclophosphamide: in 142 people, lung function improved over two years in both groups and the trial did not show that one was better. Mycophenolate was better tolerated (Tashkin et al., 2016).
  • Tocilizumab: lung-function results favored it over placebo, suggesting it might preserve lung function in early lung disease with high inflammation markers (Khanna et al., 2020).
  • Nintedanib (an antifibrotic): in 576 people the yearly decline in lung capacity was smaller than with placebo, by about 41 ml; diarrhea was the most common side effect (75.7% versus 31.6%) and skin thickening did not improve (Distler et al., 2019).

5. Lung blood vessels, heart and kidneys

Arthritis UK says pulmonary hypertension (high blood pressure in the lungs) is a rare complication, so you will have regular tests of your lungs and heart; if needed, it can be treated with medicines such as bosentan, ambrisentan, sildenafil or prostacyclins (Arthritis UK). A review reports it occurs in about 10% of people with systemic sclerosis, is usually diagnosed late with severe symptoms, and may be caught earlier by yearly screening (echocardiography, a breathing-test-and-blood-test approach, or the DETECT algorithm) (Weatherald et al., 2019). For the kidneys, Arthritis UK says renal crisis can be treated or prevented with blood-pressure medicines, especially ACE inhibitors (Arthritis UK); a 2023 review urges early collaboration between rheumatology and kidney doctors (Cole et al., 2023). See our blood pressure and kidney guides.

6. Heartburn, gut and joints

Arthritis UK says antacids are usually effective and a proton pump inhibitor (a medicine that reduces stomach acid) can be added; constipation, diarrhea, swelling or incontinence call for a gastroenterology referral, and extra bowel bacteria can be treated with antibiotics. Pain relievers and anti-inflammatory medicines help with joint pain and swelling (Arthritis UK); the ACR also lists antacids and proton pump inhibitors for heartburn (ACR). Ask your doctor which pain relievers are safe for your kidneys, stomach and blood pressure. See our acid reflux guide.

What it costs

Visits, tests and prescriptions: cost estimate being researched. Medicare Part B helps pay for medically necessary outpatient physical therapy and occupational therapy, with no yearly dollar limit; after the deductible you pay 20% of the Medicare-approved amount (Medicare.gov, Medicare.gov).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

We found little research on chiropractic care for scleroderma, and none of the medical or patient-information sources we read lists spinal manipulation as a treatment for it. MBHA therefore does not present chiropractic as a treatment for the condition.

Where a chiropractor can help

  • Recognizing when to refer. A sudden blood-pressure rise, fingertip sores, breathlessness or trouble swallowing need medical attention first (see the top of this page).
  • General musculoskeletal care for a coexisting back or neck problem, if you have one (see our back pain and neck guides).

Safety

Mild side effects — more pain, stiffness or headache, mostly gone within 24 hours — are common after spinal manipulation. Serious problems are very rare but possible, and may be more likely in people who have underlying health problems that increase their risk of injury (NCCIH). Because scleroderma can stiffen joints and affect the skin, tell the chiropractor your diagnosis and medicines. MBHA suggests asking for gentle techniques, a warm room, and no pressure over any fingertip or skin sore.

Medicare coverage

Part B covers only spinal adjustments by a chiropractor to correct a subluxation, by hand or with a device called an activator. It does not cover X-rays, massage or acupuncture ordered by a chiropractor. After the deductible you pay 20% of the Medicare-approved amount (Medicare.gov).

What it costs

Paying cash, a follow-up visit typically costs about $55 to $100 and a first appointment about $90 to $200 (The Pricer). Ask how many visits to expect.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is a technique in which practitioners insert fine needles into the skin; in the United States it is most often used for pain (NCCIH). People with scleroderma sometimes try it for Raynaud’s, pain or gut symptoms. The studies we found were small or were case reports; we did not find large trials.

What the research says

  • Raynaud’s (any cause): a 2023 review of six trials (272 people) found acupuncture was associated with more remissions and slightly fewer daily attacks, but the authors cautioned about small samples, very low quality evidence and high risk of bias (Zhou et al., 2023).
  • Secondary Raynaud’s (the type in scleroderma): a double-blind trial of weekly acupuncture for eight weeks found improvement in both the real and placebo groups and no significant difference in attacks or skin circulation; the authors said much larger studies would be needed to find a possible small benefit (Hahn et al., 2004).
  • Gut symptoms: a 2014 review of research from 2005 to 2012 found only four original articles on complementary therapies in systemic sclerosis. Acupressure and electroacupuncture showed some self-reported and measured improvement of gut function or symptoms in small patient groups, and the authors called for larger studies (Sallam et al., 2014).
  • Case reports: one report describes a successful outcome with acupuncture in two women whose disease had not responded to medicines (Karatay & Uzkeser, 2015); case reports cannot show cause and effect.

In short: acupuncture is unproven for scleroderma, and the one careful trial in secondary Raynaud’s was negative. It may be a reasonable comfort measure to discuss alongside — not instead of — medical care.

Safety

Relatively few complications have been reported, but non-sterile needles or improper treatment can cause infections, punctured organs and nervous-system injury. The FDA requires needles to be sterile and single-use (NCCIH). MBHA suggests telling your acupuncturist about fingertip ulcers, calcium lumps, any blood thinner, and the diagnosis, and asking that needles avoid sore or fragile skin and that the room be kept warm.

Medicare coverage

Part B covers acupuncture (including dry needling) only for chronic low back pain, so scleroderma is not covered. Where it does apply, Medicare covers up to 12 treatments in 90 days from a doctor or other practitioner with the required degree and license, and you pay 20% after the deductible (Medicare.gov).

What it costs

Published cash prices run about $125 to $230 for a first private visit and $90 to $185 for follow-ups; community clinics can be near $50 to $90 a visit (The Pricer). Ask about package prices and insurance.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herbal remedy or supplement has been proven to treat scleroderma. Arthritis UK says there is a lack of scientific evidence that complementary medicine eases the symptoms of systemic sclerosis; most are thought to be safe, but you should use a reputable, registered supplier and check with your doctor first. The same page says supplements of vitamins E and C, fish oil, ginger or ginkgo can help, though it points to no trial evidence, and that vitamins should be stopped if they have not helped within three months (Arthritis UK).

What the research says

  • Reviews: a review of complementary therapies noted that small studies suggest vitamins D and E, probiotics, turmeric, L-arginine, essential fatty acids, broccoli, biofeedback and acupuncture may be beneficial, but that large randomized trials have not been done (Showalter et al., 2019).
  • How common is it? In a US study of early systemic sclerosis, one in four patients used complementary therapies, many for more than a year, and users reported better physical and mental functioning, which the authors suggested might reflect more self-motivation to manage symptoms (Hunnicutt et al., 2008). In a 2024 survey of 100 patients, 55 had used herbal products, mostly green tea, St. John’s wort and turmeric; patients reported benefit, but the authors said studies of effectiveness are insufficient (Yildirim et al., 2024). A small French survey (23 respondents) found widely varying herbal use and no obvious toxicity, but is too small to judge safety (Blaise et al., 2025).

Safety

Supplements can interact with medicines or carry risks if you have certain medical conditions or are going to have surgery, and what is on the label may not be what is in the product. For example, St. John’s wort makes many medicines less effective (NCCIH). People with systemic sclerosis often take several medicines (for blood pressure, reflux, circulation and the immune system), so tell your doctor and pharmacist about every product you take. Never take a supplement instead of a prescribed medicine, and see our medication safety guide.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage can feel soothing and may help with stress and stiffness, but it is not a treatment for scleroderma itself. Most of the research is on a specialized technique rather than on general massage.

What the research says

  • Manual lymph drainage is a specialized technique that stimulates the lymphatic system to reduce swelling. In a small 2011 study, 20 people with swollen hands in the early (edematous) phase of systemic sclerosis received weekly sessions for five weeks, and 15 were observed. The treated group had less hand swelling and better hand function, pain and quality of life, with most gains still present nine weeks later; the observation group did not improve (Maddali Bongi et al., 2011). A 2015 review of nonpharmacologic treatments counted manual lymph drainage among three high-quality randomized trials, while noting the evidence base overall is very limited (Willems et al., 2015).
  • Warm paraffin wax massage of the hands can help keep skin flexible and reduce joint discomfort, but Arthritis UK says you must not use a wax bath if you have any open finger ulcers (Arthritis UK).

Safety

The risk of harm from massage appears low, though rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue massage or in people at higher risk (NCCIH). MBHA suggests: tell the therapist you have scleroderma and which medicines you take; ask for a warm room and gentle pressure; avoid massage over open sores, ulcers, calcium lumps or very tight, fragile skin; and skip deep-tissue work. A therapist is not a substitute for evaluating the warning signs at the top of this page.

What it costs

One national chain charges about $70 to $90 a month on a 12-month membership (The Pricer); prices elsewhere vary, and specialist lymph-drainage therapists may charge differently. Medicare does not cover massage therapy (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Much of what helps scleroderma happens between appointments. An MBHA Wellness Coach can help you build these habits — alongside, never instead of, medical care. A coach does not diagnose or treat, and does not change medicines.

Plan for warmth

The ACR advises keeping your body, hands and feet warm with layered clothing, boots and gloves in cold weather, and protecting fingers and toes from activities that could injure the skin (ACR). Arthritis UK suggests keeping warm from top to toe, including a hat; thermal clothing, hand warmers and heated gloves and socks; and layers rather than thick clothing, because layers trap heat (Arthritis UK). MedlinePlus likewise advises dressing warm and avoiding cold or wet environments (MedlinePlus). A coach can help you build a “go bag” and routines for winter, travel, the grocery store and work.

A daily skin, hand and mouth routine

MedlinePlus suggests moisturizers to lessen stiffness, sunscreen before going outdoors, avoiding hot baths and showers, harsh soaps and household cleaners, and regular dental checkups (MedlinePlus). Arthritis UK recommends putting cream on your hands whenever they have been in water, avoiding irritating detergents and lanolin soaps, and using dressings to protect broken or painful skin (Arthritis UK). The NHS also lists moisturizing to keep skin supple and relieve itching (NHS). A coach can turn this into a routine you actually keep and remind you to bring hand and mouth exercises from your therapist into the day.

Meal pacing for heartburn and swallowing

Arthritis UK suggests six small meals instead of three large ones, eating slowly, chewing thoroughly, drinking water with meals, eating your largest meal at midday, eating little in the evening, and raising the head of your bed a few inches (Arthritis UK); the ACR gives similar tips (ACR). A 2024 review found studies of diet in systemic sclerosis too few to support any conclusions (Parodis et al., 2024 review), so a coach can help you track what works for you and share it with your doctor or a dietitian.

Movement and exercise

The EULAR recommendations for non-drug care say people with systemic sclerosis should be offered education and support for physical exercise, quitting smoking and avoiding cold, and that mouth and hand exercises are important (EULAR, 2024). A 2019 review found randomized trials of hand, orofacial and aerobic exercise showed effects on hand function, mouth opening, fitness and quality of life, but called the evidence scanty (Liem et al., 2019). A 2024 review concluded exercise and education should be considered to improve physical function, especially of the hands and mouth, and are not a substitute for medicines (Parodis et al., 2024 review). A coach can help you schedule short, regular sessions.

Quitting smoking

Arthritis UK says smoking reduces blood flow to the skin and is very likely to make Raynaud’s worse (Arthritis UK). The NHS and MedlinePlus both advise stopping (NHS, MedlinePlus). A coach can help you set a quit date, line up cessation services and plan around cravings.

Stress, mood and support

Stress can reduce blood flow, especially with Raynaud’s, and living with changes in your skin can be upsetting; Arthritis UK suggests talking to family, friends, a clinic nurse or your doctor, and notes that talking with others who have the same condition can help greatly (Arthritis UK). The ACR notes that depression or mood problems are possible and recommends support from family, patient groups or a psychologist if needed (ACR). See our depression and anxiety guides; a coach can help with breathing and relaxation skills and with finding peer support, but is not a replacement for counseling.

Staying on top of monitoring

Keep a simple log: blood-pressure readings if your doctor asks for them, breathing changes, swallowing or weight changes, new sores, and the date of your last yearly check-up. MBHA suggests bringing it to each visit, along with a written list of questions.

Another approach

Hand therapy, mouth care & daily living

Stiff hands and a tight mouth can make daily life harder, and therapy is a core part of care. The NHS says regular physiotherapy and stretching can help keep muscles supple and loosen tight skin, and that an occupational therapist can suggest changes to your home and equipment to make daily life easier (NHS). MedlinePlus lists physical or occupational therapy to help with pain, build muscle strength and learn easier ways to do everyday tasks (MedlinePlus). Arthritis UK says a physiotherapist or specialist hand therapist can teach exercises to keep joints mobile and may suggest splints, and a physiotherapist may give exercises for the face (Arthritis UK).

Another approach

Pregnancy & children

The NHS says women with systemic sclerosis may find it harder to get pregnant and could have a slightly higher risk of miscarriage and premature birth; however, if the pregnancy is planned with a doctor during a period when the condition is stable, there is no reason a woman with systemic sclerosis cannot have a successful pregnancy (NHS). Talk to your rheumatologist before trying to conceive, and ask which of your medicines are safe in pregnancy. See our pregnancy guide.

The NHS notes that localized scleroderma can affect both children and adults, and linear morphea mostly affects the arms and legs of children, can affect bone and muscle and may cause permanent problems such as shortened limbs; children are rarely affected by systemic sclerosis (NHS). A child with thick, discolored or tight skin patches should be seen by a doctor.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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