Scleroderma has many forms and a number of different symptoms that may present themselves singly or in many combinations at various times throughout the course of the disease. Some symptoms develop with relative suddenness; others take years to develop. The exact course the disease may take is unpredictable, and the prognosis will vary from individual to individual. Scleroderma is a chronic, life-long disease. At the present time there is no known cure, but as with other chronic diseases there are many means available to control or manage its symptoms. Many persons with the disease have few or minimal symptoms and are able to lead a normal or nearly normal life.
 
There may be periods of time when the person with scleroderma
will be free of troubling symptoms and feel well. At other times, he or she may fee quite ill. Spontaneous improvements may occur. The skin, in particular, sometimes softens and becomes more pliable after a number of years. Spontaneous remissions, times when symptoms may actually disappear, may also occur and may continue for long periods.
 
Scleroderma patients need to be alert to their symptoms. In being alert to symptoms, it would be a mistake to assume that every symptom or condition that develops is necessarily related to, or the result of scleroderma. Persons with or without scleroderma do develop other illnesses. Your physician can help to distinguish what is related to scleroderma and what is not, and recommend appropriate treatment.
 
The symptoms of scleroderma vary greatly from individual to individual, the manner in which each person responds to treatment also varies greatly, and there are many treatment options. It is important that you and your physician who is experienced with scleroderma work out an individually tailored program to meet your needs.
 
Regular exercise helps improve overall health and fitness. Your physician may recommend an exercise program for you or send you to a physical therapist who will help develop an appropriate program for you.
 
Your physician may recommend an exercise program involving activities such as stretching, walking, or swimming. Persons with scleroderma may find that their tolerance for activity and movement is below normal, so activities should be carried out in moderation, resting when tired. Individual exercises should be performed gently and with care, and the exercise program should be built up gradually.
 
Physical therapists are available to assist the person with scleroderma in the development of an appropriate program. Such a program may consist of "range of motion" exercises, paraffin baths, hydrotherapy, strengthening exercises for muscle weakness, and gentle massage.
 
Joint protection means protecting swollen and painful joints from stresses and strains that can make them hurt more. Lifting or carrying heavy objects, for example, can strain and hurt your joints. The goal is to minimize further damage and to reduce the possibility of infection. You can maintain their mobility and function through stretching and "range of motion" exercises. Physical and occupational therapists can show you new ways to do activities, such as opening doors, drawers, getting out of chairs, carrying packages, ironing clothes, and brushing teeth.
 
Skin protection is also very important in order to keep a good supply of blood flowing to your skin, and to protect skin from injury. Dressing warmly will help do this. Keeping your body warm helps open the blood vessels in your arms, hands, legs, and feet. Here are some tips for keeping warm:
 
    *  Wear gloves outside especially if you have Raynauds Phenomenon.
   *  You should also wear gloves inside when you reach into your freezer
        or have your hands in cold water.
   *  Always wear a hat in cold weather, since body heat is lost  from an              uncovered head.
   *  Cover your face and ears with a scarf.
   *  During cool weather, wear thin cotton garments next to the skin.
       The cotton layer moves the sweat away from the skin, and keeps the
       sweat from cooling your body.
   *  Wear wool as it is warmer than most fabrics or materials.
   *  Wear many thin layers and it will keep you warmer than one thick
       garment.
   *  Wear loose-fitting boots and shoes that won't cut off the blood
       supply and will allow you to wear warm thermal socks or layers of
       socks.
   *  Use a cold water room humidifier to keep skin moist.
   *  Avoid using strong detergents or other substances that irritate your
       skin.
   *  Try soap, creams, and bath oils that are designed to prevent dry skin            until you find the ones that give you the best results.
   *  Enlist help from family and friends. In the winter let family or                       friends get your paper from outside or start your car.

Stress management is very important with this disease. There are emotional and social problems that come with having a chronic disease. Even if you can usually manage the illness, there may be times when you feel overwhelmed by problems.
 
Emotional stress plays a part in reducing blood flow. To help reduce the effects of stress you should:
 
   *   Get enough sleep. You may need to take short naps during the day.
   *   Try to avoid situations that make you tense.
    *   Try to keep feelings of anxiety and fear from getting the best of you.
   *   Express your fears and anger about what is happening to you. It is
          often helpful to confide in family, friends, your doctor, or a
        counselor. Family members also benefit from such open talks. If
        they can understand your problems and your feelings, they can                   help you deal with them.
   *   Ask your doctor to refer you to a social worker, counselor, support
        group, or community mental health center.
 
A person with scleroderma may feel alone and uncertain about where to turn for help. He or she may experience a number of other feelings and emotional reactions from time to time, including shock or disbelief, fear, anger, denial, self blame or guilt, grief, sadness or depression. Family members may have some of the same feelings. Having these feelings is neither good or bad we just have them. Sharing them with family members or friends can be helpful. Professional counseling is also available to assist persons with scleroderma and their family members who are having a difficulty coping with their feelings.
 
No diet will cure scleroderma, but you should eat balanced meals and stay at a sensible weight. If you have trouble swallowing, eat slowly and chew thoroughly. Also drink water or another beverage to soften food. Eat high fiber foods to help cut down on constipation. Try eating six small meals a day rather than three large ones, so food digests better. You should also avoid foods that cause heartburn or gas, such as spicy foods. Do not lie down for about four hours after a large meal. Eat your largest meal in the middle of the day rather than close to bedtime. You can also raise the head of your bed by putting six-inch blocks under the end. This will help keep your stomach acid from washing into your esophagus while you sleep.
 
Dental care is also very important. Some scleroderma patients experience dry mouth or get Sjogren's Syndrome. This can cause an increase in cavities and tooth decay. Prevent tooth and gum problems by brushing and flossing your teeth daily and by visiting a dentist regularly.
It is very important for scleroderma patients to take all their prescription medications as prescribed. You should also read label warnings and follow instructions carefully. You should advise your doctor of any drugs being taken for other conditions or over the counter drugs that you are taking. Any side effects from drugs you are taking should be reported to your doctor immediately.
 
There are also a number of general common sense measures that the scleroderma patient can do. Avoid over fatigue by getting sufficient rest and knowing your limitations. You should also learn to control and minimize stress. Eating well-balanced meals and maintaining a sensible weight. Having good hygiene, especially of the skin, teeth, gums, and feet is very important.
 
Participating in your own health care is very important for those of us with scleroderma. You also have to have a good doctor who knows about your disease and who you feel comfortable with. You both are part of a team and you should be able to communicate well.
 
Your health team begins with your physician, but can include many other health care professionals such as a dermatologist, medical specialists, internist, rhuematologist, nurses, dentist, physical and occupational therapists, and psychologists.
 
Joining a scleroderma support group is also helpful so you can meet or exchange information with others who have the same problems. You can also learn more about your disease.