Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

World Scleroderma Day

Plant a Seed

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In Australia, the sunflower has become the symbol of scleroderma awareness—because those of us with the disease feel better in the warmth of the sun. I like this idea a lot. Enough, in fact, to consider trying my hand at planting some sunflowers, if not this summer, then next.

1428247_41776650Yesterday, on June 29, scleroderma associations around the globe marked World Scleroderma Day. In nearly two dozen countries in North America, Europe and Oceania, a month of awareness-building culminated with a host of activities, from hospital presentations and meetings of scientists to art gallery exhibitions and a social media series of 25 second videos, in recognition of the estimated 2.5 million people diagnosed with scleroderma worldwide. Today, June 30, the need for a cure will be presented to the European Parliament in Brussels.

June 29 is significant because it marks the death in 1940 of the brilliant artist Paul Klee, who suffered from systemic scleroderma. Klee’s later work was strongly influenced by his disease, even as his last few years were among his most prolific.

Paul Klee’s legacy helped to inspire the formation of the World Scleroderma Foundation, which is based in Basel, Switzerland, and draws together world experts in scleroderma research and patient groups in an effort to support research for a cure. The WSF’s lead patron is Klee’s grandson, Alexander, and his family.

While 2.5 million individuals with scleroderma represents just a sliver of the world’s 7.3 billion people, The WSF makes a compelling argument for the importance of scleroderma research on its website: Not only is the search for a cure needed for the millions who suffer from the disease—most of whom are women of childbearing age—but also scleroderma is a “linchpin disorder”: 

A breakthrough in understanding scleroderma would doubtless have a strong impact on many other diseases involving abnormal scarring and blood vessel injury. This might include conditions as diverse as interstitial lung disease, intestinal hypomotility disorders and many illnesses with blood vessel injury as their basis.

Which brings me back to sunflowers. Each sunflower head can contain as many as 2,000 seeds, each of which, in turn, with the right soil, sun and moisture, becomes another sunflower. If we could find a cure for scleroderma, imagine how many other millions of people who struggle with related diseases could be helped, as well.

Plant a seed to find a cure for scleroderma. Visit wolrdsclerodermaday.org to see what’s going on around the globe in support of research for a cure, or make a donation here in the U.S. to the Scleroderma Research Foundation or the Scleroderma Foundation. We’re all in this fight together.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Pillar of Salt

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Surrounding Israel’s Dead Sea, spires of salt tower like sentinels, guarding barren hillsides. In bright, humid heat, they shimmer, casting craggy shadows on salt-infused sand. These ancient formations no doubt inspired the biblical story of Lot’s wife, who, fleeing from God’s destruction of Sodom and Gemorrah, made the fatal error of pausing to look back and was frozen into a pillar of salt. Indeed, a salt formation near the Dead Sea is named for her.

I once read somewhere that Lot’s wife’s plight was a metaphor for scleroderma. In its most virulent form, this deforming disease locks the body inside hardened skin, from which there is no escape. But scleroderma takes many forms, unique to each individual. And those of us who live with this disease in no way brought it upon ourselves. So the metaphor, while dramatic, breaks down for me.

Nonetheless, scleroderma has been known since ancient times. The Greek physician Hippocrates first described it as thickened skin, around 400 BCE. Carlo Curzio, an 18th century Italian physician and dermatologist, gave the first detailed description of the disease in 1753. His monograph, published in Naples, presented the case of a 17-year-old woman named Patrizia Galiera, suffering from hardened skin that varied in thickness, tightening around her mouth and neck. He noted that her skin lacked warmth, but that her pulse, respiration and digestion appeared normal.

Over the course of 11 months, her treatments consisted of warm milk, vapor baths, leeched blood and small doses of quicksilver. Miraculously, at least according to Curzio’s report, Patrizia’s skin softened and she fully recovered. (However, we will never know if she eventually experienced symptoms of mercury poisoning from the quicksilver.)

During the 19th century, physicians began to differentiate the variations within the broad disease category, including localized scleroderma and en coup de sabre (morphea), the latter so-named because it dents the forehead like a sword blow and then deforms the skin on only one side of the face. Scleroderma also found its way into fiction, afflicting a character in a Sherlock Holmes story by Sir Arthur Conan Doyle, “The Case of the Blanched Soldier.”

The connection between scleroderma and abnormal vasoconstriction was documented by the French physician Maurice Raynaud in 1863. He described the case of a farmer whose arms became numb in winter, and whose hands gradually hardened and darkened. Well-known to many of us who suffer from numb, tri-colored hands, this condition is named for him—Raynaud’s Syndrome or Disease, depending on whether it accompanies a disease like scleroderma or is free standing.

Six years after Raynaud’s discovery, the American Journal of Medicine published the first American report of scleroderma, with a history of three patients. More about the history of scleroderma can be found here.

Today, knowledge of the many variants of scleroderma is deeper and broader than at any other time in history. Research into all aspects of the disease progresses, although a cure has yet to be found. But the rarity of scleroderma—afflicting a median of only 15 individuals per million each year, worldwide—makes it all the more elusive.

Last week, a post I wrote two years ago about a recent breakthrough in scleroderma research found its way around the Internet. Several readers shared poignant stories about experiences with the disease and the loss of loved ones to the most deadly variant. All shared hopes that a cure will soon be found. I was struck, however, by another common thread: Scleroderma is so rare, and so varied in its presentation, that a number of patients suffered all the more because they were misdiagnosed at early stages of the disease. We do not all present as obvious scleroderma patients, with hardened, mask-like faces and clawed hands.

As important as finding a cure, it is essential that physicians in the field, especially those who live and work far from urban centers, with less access to current research, learn to recognize scleroderma and know about available treatments. I applaud the work of the Scleroderma Foundation, which has begun to offer online CME/CNE training for physicians and nurses, in tandem with the Postgraduate Institute for Medicine, to reach out in this regard.

Every step helps—whether in the lab or in medical school classrooms—to ease the path of those with scleroderma throughout the world. We are not pillars of salt. We are not responsible for our illness, helpless or hopeless. We need to support those who are working for a cure, and those who are educating physicians to recognize and properly treat scleroderma. June 29 is World Scleroderma Day. Make your mark.

You can find more information about current research and education efforts here:

Photo Credit: M Disdero 25/02/2007, Pilastro di sale sul Mar Morto, indicato dalle guide turistiche come la moglie di Lot trasformata in statua di sale durante la distruzione di Sodoma. Wikimedia Commons

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.