Skin Management in a Patient with Diffuse Cutaneous Systemic Sclerosis

Patient description

I would like to share an interesting case and seek colleagues’ input regarding skin management strategies.

We recently evaluated a 60-year-old female with diffuse cutaneous systemic sclerosis (dcSSc), diagnosed in her youth. She has never received regular immunosuppressive therapy. Her current medical history is significant for hepatic cirrhosis, and her only medication is ursodeoxycholic acid (UDCA).

After many years of self-isolation from medical care, she presented to our clinic motivated solely by her perioral wrinkles and overall skin aging. During our consultation, we discussed:

• The importance of resuming rheumatology follow-up

• Completing her vaccination schedule

• Regular skin monitoring for disease-related changes

Physical Examination:

The patient presented with classic cutaneous features of longstanding dcSSc, including:

• Skin darkening

• "Salt-and-pepper" hyperpigmentation and depigmentation

• Loss of appendicular hair

• Dry, atrophic skin

• Capillary changes at the nailfolds

• Degos-like lesions
  

Case description

Given that her primary motivation to re-engage with the healthcare system was cosmetic, I felt it was appropriate to offer a skin-improving approach in parallel to medical counseling, rather than solely advising a return to immunomodulatory therapy.

Initial Treatment Plan:

• Laser therapy: Clarity Laser protocol, combining 755 nm and 1064 nm Q-switched wavelengths

• PRP  injections for tissue regeneration and bio-stimulation

• Home care:

  • Daily broad-spectrum sunscreen

  • Hydrating cream

  • Topical Vitamin C

I am considering the introduction of topical retinol, but would appreciate colleagues’ input regarding safety and efficacy in a patient with longstanding dcSSc and thin, potentially fragile skin.

Questions for Discussion:

1. Have you used retinol in systemic sclerosis patients with similar presentations?

2. Any other technologies or regenerative products (e.g., biostimulatory injectables, fractional lasers, RF, or ultrasound-based treatments) you have found effective in these cases? Have you used bio-stimulators, bio-regenerators, PDNR, or exosomes to improve skin quality in this context?
   

3. Any pearls on balancing skin rejuvenation with safety in patients with compromised systemic and cutaneous health?

4. Would you have chosen a different therapeutic approach as your first step in this case?