Many people with scleroderma develop white lumps under the skin of their fingers or other parts of the body, known as cal- cium deposits or calcinosis. These can range in size from small specks to collections as large as tennis balls. A number of causes for these calcium deposits have been suggested, including a lack of oxygen being delivered to the skin, chronic inflammation of the ves- sels, and an imbalance of components that regulate the amount of calcium entering skin cells. However, it is unclear exactly how these problems result in calcinosis. Calcium deposits are very painful, and can interfere with functioning, especially when they form on the hands. Sometimes the de- posits can break through the skin and drain white material, which may lead to an ulcer or infection. Ulcers incured from hardening of the calcinosis which can cause open sores and infection as well. In this case, it is im- portant to consult a physician, who may prescribe antibiotics. I have been dealing with calcinosis in my hands for some years and more recently my arms and elbows. The deposits for me seem to develop at any pressure points. The calci- nosis deep below the skin I believe starts in liquid form, then transforms to solid as it move through the tissue. Once it is in solid form it is like sharp bone or glass which can be traumatic to the fingers in sores and pain. There isn’t any medication that has proven to prevent, slow or reverse calci- nosis at this time. I participated in a trial at Stanford University for a drug call Oren- itram that has finished and the results should be published soon. I was not success- ful with it because once I increased to higher levels of the medication, my diges- tive system which is compromised could not tolerate higher levels of oral medica- tion. (more pills). I did see remarkable improvement in circulation and raynauds until I had to decrease the dosage. The best care that has allowed me to take care of my fingers with the calcinosis is through the wound clinic at Jamestown Re- gional Medical Center. My specialist Amanda Lausch is very informed on sclero- derma, and has worked with me to not only provide top care through standard Healog- ics practices, but to tailor my care for me as well as train me to assist in my own per- sonal care. Not all wound clinics are the same. I recommend you find a certified Healogics facility and specialist.

Below are photos and x-rays of the calcinosis of my actual hand. Click on the photos for larger view.

Raynaud’s phenomenon affects roughly 95% of people with scleroderma. Ray- naud’s phenomenon is characterized by so- called attacks that usually occur in response to cold temperatures or sudden drops in temperature. During a Raynaud’s attack, small blood vessels in the fingers (and, less frequently, the toes, ears, nose, and even tongue) suddenly clamp down. The fingers typically turn white as blood flow is decreased, then blue – meaning that the finger does not have enough oxygen – and then red as blood flows back into the fingers. During a Raynaud’s attack, people may experience a number of uncomfort- able sensations, including cold, numbness and pins and needles, followed by burning, throbbing, and pain as circulation returns to normal. The most effective way to man- age Raynaud’s is to maintain a warm core temperature (e.g. wear layers, shawls, hats, etc.) and to avoid possible triggers for at- tacks, such as cold temperatures or ‎sudden drops in temperature, smoking, and certain medications. What you can do: • Avoid cold temperatures and sudden drops in temperature: Dress in layers of clothing to keep the body core warm. Keep your fingers warm with mittens, gloves, and electric/chemical hand warmers for extra warmth. Use insu- lated drinking containers. If you are getting an iced beverage, place a nap- kin or a drink sleeve over the cup. Try to avoid sudden changes in tempera- ture, such as jumping into cold water or being abruptly exposed to air-condi- tioning in the summer. • Avoid vaso-constricting drugs: Certain drugs can worsen Raynaud's by causing the blood vessels to spasm and con- strict. These include: beta-blockers prescribed for hypertension or heart disease, amphetamines, migraine medi- cations containing ergotamine or serotonin-receptor antagonists, some attention deficit disorder medications, diet pills, herbs containing ephedra, and nasal drops or sprays prescribed for rhinitis or flu. • Stop smoking: Regular cigarette smok- ers are known to have reduced blood flow to their fingers and toes, and there is strong clinical evidence that smoking cessation is associated with improve- ment in Raynaud’s. There are many other health benefits associated with smoking cessation. If you smoke, talk to your physician about programs that can help you quit. Similar adverse ef- fects on digital blood flow occur as a result of marijuana consumption. • Reduce emotional stress: There is no strong clinical evidence to support the link between Raynaud’s and emotional stress. Nonetheless, since ongoing stress is thought to narrow the blood vessels, practicing stress management skills like relaxation may be beneficial over time. • Ask your physician about medications: In addition to avoiding triggers, some medications like calcium channel blockers are helpful for preventing at- tacks. Consult your physician about whether these medications are right for you. • When a Raynaud’s attack does occur, try warming up your hands by holding them under warm water, or placing them on a heater or a hot water bottle. If you do not have access to one, you can also put your hand under your armpits to warm them, rub your hands together, or rotate your arms in a wind- mill pattern to increase circulation.