Scleroderma-like lesions

It is notable that cadmium as well as mercury and gold can initiate or aggravate autoimmune manifestations in normal or autoimmune-prone animals, respectively. It would seem likely that these heavy metals have the same effects on humans, presumably by a similar mechanism. Autoimmune manifestations induced by heavy metals include lupus-type nephritis, autoimmune haemolytic anaemia, and skin diseases, such as pemphigus and scleroderma-like lesion. Some manifestations of immune-mediated nephritis and elevation of circulating autoantibodies have been noted in case-studies of persons exposed to gold and cadmium as well as mercury (Ohsawa, 1993 Bigazzi, 1994, 1999). 

In addition, silicone-containing medical devices, particularly breast prostheses, have been reported to cause serum-sickness-like reactions, scleroderma-like lesions, and an SLE-like disease termed human adjuvant disease [11,23]. Some patients may also present with granulomas and autoantibodies. Human adjuvant disease is a coimective tissue or autoimmune disease similar to that of adjuvant arthritis in rats and rheumatoid arthritis in humans. Autoimmime disease-like symptoms usually develop 2-5 y after implantation in a small percentage of people that receive implants, which may indicate that there is a genetic predisposition similar to that for... 

The first large study was conducted in Rumania in 1963, where 168 PVC workers had been observed over 4 years (Suciu et al. 1963). The symptoms included pruritus of the arms and face, and scleroderma-like lesions which mostly disappeared after removal from the workplace. Later on, the disease was described in detail and labeled as occupational acro-osteolysis (OAOL) in England, France, and the USA (Cordier et al. 1966 Harris and Adams 1967 Wilson et al. 1967 Dinman et al. 1971 Markowitz et al. 1972). The disease is characterized by Raynaud s phenomenon, papular-fibrotic skin lesions on the wrist and dorsa of the hands, and osteolysis in the middle of the distal phalanges (bullet holes), mainly of the first three fingers, which became shortened and shapeless. OAOL occurred only in those workers who had been exposed to the VC monomer and was most common in reactor cleaners (Lelbach and Marsteller 1981). 

Histopathological examination of scleroderma-like lesions showed distended collagen fibers, shrinkage of elastic fibers, interstitial edema, sometimes perivascular lymphocytic infiltrates, swollen endothelial cells of the enlarged capillaries, and marked acanthosis in the epidermal layer (Czernielewski et al. 1979). 

In 1983, Walder reported of six patients with limited scleroderma who were exposed to aromatic hydrocarbon solvents, such as benzene, toluene, xylene, white spirit, and diesel oil. Unlike chlorinated hydrocarbons, these aromatic hydrocarbons do not cause systemic disorders. The scleroderma-like lesions were limited to hands and feet, body parts directly exposed. 

Paradoxically, penicillamine is occasionally involved in the development of rare diseases for which it is also sometimes used, such as systemic sclerosis-like lesions (245) and circumscribed scleroderma (or morphea) (246,247). 

Two distinct types of skin lesions have been described in patients taking pentazocine scleroderma-like changes, subcutaneous abscesses, cellulitis, ulceration, muscle atrophy and granulomas (all of which are well-recognized consequences of pentazocine abuse), and a generalized erythematous desquamative rash. 

A fairly strong and consistent association between exposure, primarily in occupational settings, to solvents (e.g. trichloroethylene) and scleroderma has been reported in numerous epidemiological studies (see chapter 8). Scleroderma-like diseases can also be induced by other chemical compounds, such as drugs (D Cruz, 2000) and silica ( Erasmus syndrome ). Workers exposed to vinyl chloride monomers exhibit clinical features that resemble systemic sclerosis, such as fibrotic skin lesions, pulmonary fibrosis, and skin capillary abnormalities. However, vinyl chloride disease also harbours several features that are clearly distinct from systemic sclerosis. After exposure is discontinued, skin lesions, capillary abnormalities, and acroosteolytic lesions revert to nearly normal (Haustein Ziegler, 1985). 

There are no reports of adverse events in exposed humans. It has been reported to have induced a morphea-like lesion (localised scleroderma) with alopecia in a cat given a topical treatment of emodepside plus praziquantel." The lesion resolved after about 60 days following treatment with minoxidil for the alopecia. 

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