This blog post summarises the key insights from the latest Virtual Education Session (VES) presented by Associate Professor Amanda Saracino, who is a fellow of the Australian College of Dermatologists and an associate professor with the University College London. She’s also recognised as a consultant dermatologist by the Royal College of Physicians and General Medical Council in the UK and is an international fellow of the American Academy of Dermatologists. Her extensive experience includes working in a variety of clinical and academic settings in both Melbourne and London and now works in Melbourne in a private practice at Emeritus Research.

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What is Scleroderma?

From a dermatologist’s perspective, scleroderma — literally meaning ‘hard skin ’— is an umbrella term. It includes both systemic sclerosis (which can affect internal organs) and morphea (a localised skin form). Though their skin symptoms look identical under the microscope, systemic sclerosis has broader health implications, making it essential for patients to understand which form they have.

Common Skin Symptoms

Scleroderma can cause a wide range of skin changes, including:

  • Skin tightening and thickening (especially around fingers and mouth),
  • Sclerodactyly – tightening of the skin over fingers,
  • Calcinosis – calcium deposits in the skin,
  • Pigmentation changes, and
  • Visible capillary changes around the nails.

These symptoms often have a significant emotional and practical impact, even if they’re not the primary medical focus like lung or heart issues, so it’s important to advocate for your skin health with GPs and specialists.

Skincare Tips from a Dermatologist

  • Moisturising Basics

– Ointments are thick and greasy — ideal for very dry skin.

– Creams are a good middle ground for hydration.

– Lotions are light and best for less dry or sensitive skin.

Moisturiser choice should be based on personal preference and skin needs. Some top product recommendations include:

– “Propaira Moisturising Cream” (Australian-made and highly hydrating),

– “CeraVe” (rich in ceramides to repair the skin barrier),

– “Neutrogena Norwegian Hand Cream” and “La Roche-Posay Cicaplast” for hands.

  • Face Care for Sensitive Skin

Sensitive facial skin needs extra care. Some suggestions:

– “La Roche-Posay Toleriane” range – especially the Cicaplast B5 cream,

– “Bioderma Sensibio”, and

– “Avène Tolerance Extreme” creams.

These options are hydrating and calming, ideal for inflammation and irritation. Some products may even help soften fine lines or dryness around the mouth.

  • Hand & Lip Care

– “10% olive oil in zinc paste” (from compounding chemists) is useful for fissures and finger care.

– For dry lips, “Dermal” or “Vaseline Lip Therapy” (not just regular Vaseline!) — simple, effective, and budget-friendly.

  • Sunscreen

Always use SPF 50+ broad-spectrum sunscreen!

Australian standards are stringent, so if it says “broad-spectrum,” you’re well covered for both UVA and UVB rays.

Mineral-based sunscreens (aka physical blockers) were also highly recommended, which contain:

– Zinc oxide,

– Titanium dioxide, or

– Iron oxide (often gives the cream a slight tint).

These are gentler on sensitive skin and are better at preventing sun-induced pigmentation, making them ideal for people with inflammatory or pigment-prone conditions. Amanda’s personal pick was “Propera tinted sunscreen,” which blends in well even with fair skin and offers excellent, non-irritating protection.

  • Managing Itchy Skin

Itchy skin in scleroderma can be a real struggle and often has multiple underlying causes. Key advice to follow:

– Don’t assume it’s just your scleroderma. Get a proper diagnosis, especially if the itch is new or unusual.

– Use soap-free washes like “QV” or “Cetaphil”, and moisturise regularly.

– Topical steroid creams may help if inflammation is contributing to the itch.

If standard options don’t cut it, other treatments include:

– Phototherapy (UV light therapy) for inflammation,

– Antihistamines, though these don’t work for everyone,

– Nerve-targeting creams or tablets if the itch seems nerve-related.

A popular patient-recommended product is the “Bioderma Atoderm SOS Spray”, which can be stored in the fridge for a soothing effect.

  • Telangiectasia (Red Spots/Blood Vessel Changes)

Those small red spots often seen on the face, chest, lips, or fingers are called telangiectasia, caused by blood vessel damage.

Laser treatment (like pulsed dye laser) is an option, though telangiectasia in scleroderma can be stubborn.

Tip: Always go through a medical provider (like a dermatologist), so you may be eligible for a Medicare rebate.

  • Calcinosis

Calcinosis (calcium deposits under the skin) is one of the more difficult symptoms to manage:

Start with protecting your hands and managing Raynaud’s (as poor blood flow worsens it).

– Treatments include:

  – Topical steroids (compounded at pharmacies),

  – Sodium thiosulfate injections (sometimes helpful for smaller lumps),

  – Surgical removal (though healing is often slow and complex).

It’s a tricky problem, but it was stressed that persistence and a tailored approach can help ease the pain and complications.

  • Lines and Tightening Around the Mouth

One of the more distressing visible symptoms is tightening and deep lines around the mouth. This is mainly due to fibrosis and loss of fat tissue, even after inflammation settles.

– The go-to medication is usually “mycophenolate”, but it doesn’t always reverse cosmetic effects.

– Some experimental treatments and emerging approaches may offer hope, though they’re still in early stages. 

Here are updates on these treatments:

  • Hyaluronidase Injections

Recently, a small group of patients in the U.S. were treated with hyaluronidase — an enzyme usually used to dissolve cosmetic filler. The idea? Since scleroderma causes a buildup of collagen (a bit like overfilled skin), this enzyme might help loosen and soften that tight, stiff skin.  

The early results? Promising, when done properly by experienced clinicians.

  • Lasers and Light Therapy

Treatments like Intense Pulsed Light (IPL) — typically used for pigmentation and rosacea — may also help by reducing inflammation and, in turn, easing collagen buildup around the mouth.

  • Botox

Still early days, but some research suggests Botox might play a role in relaxing the skin and muscles around the mouth, though more studies are needed.

Anti-Aging Skincare – What’s Safe and What to Avoid

A popular question was also addressed in this session: Can I still use anti-aging products with scleroderma?

The short answer: Yes — but with caution.

There are two main things to keep in mind:

  1. Avoid collagen supplements – No hard evidence, but best to steer clear when you’re dealing with a collagen-overproducing condition.
  2. Be gentle – Inflammation and skin barrier issues are common in scleroderma, so avoid irritating your skin with harsh actives or doing too much at once.

Amanda’s go-to anti-aging ingredients are what she calls the ABC trio:

A – Vitamin A (Retinoids)

  • Highly effective but also the most irritating.
  • Use a sandwich technique (moisturiser > retinoid > moisturiser) to reduce sensitivity.
  • Introduce it very slowly.

B – Vitamin B3 (Niacinamide)

  • A lovely all-rounder: improves the barrier, reduces redness, pigmentation, and inflammation.
  • Very well tolerated.
  • A recommendation: “La Roche-Posay’s Mela B3 serum”, especially good if you have pigmentation linked to scleroderma.

C – Vitamin C (L-Ascorbic Acid)

  • A powerful antioxidant and brightener.
  • BUT it’s hard to make stable (and effective) versions of it.
  • If you’re willing to splurge, “SkinCeuticals CE Ferulic” is top-tier and lasts about six months.
  • Affordable options that still pack a punch:
    • “La Roche-Posay Vitamin C10 Serum”
    • “Paula’s Choice C15 Booster”
    • “CeraVe Skin Renewing Vitamin C Serum”

Tip: Like all actives, vitamin C can irritate—especially sensitive scleroderma skin. Patch test first and start slow.

While scleroderma can make skincare complicated — there are things that help, and there is progress being made.

Whether it’s choosing the right moisturiser, trying new laser therapies, or carefully using active skincare, you don’t have to give up on feeling good in your skin. Don’t hesitate to speak to a dermatologist who understands medical skin conditions, and remember: you’re not alone on this journey.

For those living with Scleroderma, staying updated and informed can make a world of difference. Connecting with others can also be hugely beneficial. Find out more about support in your area here. 

If you’d like to gain firsthand knowledge, our National Education Sessions and Virtual Education Sessions are available to you at no charge. Our Virtual Education Sessions are held every month through Google Meet. You can sign up for these free Virtual Education Sessions here.

These sessions provide an opportunity to engage with medical professionals and seasoned legal experts who will address common inquiries about Scleroderma and related topics.