Scleroderma and environmental factors
Literature review
Summary and translation: Dr Vera Machtelinckx, general practitioner
Source: Service de rhumatologie,
Hôpital Pellegrin-Tondu, CHU de Bordeaux
O. Hallé, T. Schaeverbeke, B. Bannwarth, J. Dehais.
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| Introduction |
The cause of scleroderma is still unknown, but environmental factors and iatrogenic (caused by medical treatment) elements, such as chemical substances are questionable. It is proved that exposure to silicon dioxide causes an epidemiologically demonstrable increase in the disease incidence.
Silicone breast-implants, solvents, Spanish oil and drugs have also been examined.
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| Silicon |
- In certain mines a large number of people were diagnosed with scleroderma (South-African gold mines).
- In France and in Belgium scleroderma is recognised as an occupational illness for mine workers having worked in the underground for ten years.
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| Silicone |
- A polymer consisting out of Silicon (Si) and Oxygen (O2), and widely used in medicine for lenses and mammary (or testicular) implants.
- In laboratory animals it has not been proved that this material causes a sclerodermatous syndrome, although it causes skin fibrosis and autoantibodies.
- With silicone, scleroderma is the most occurring connective tissue disease, followed by lupus, polyarthritis and polymyositis.
- In total, only 5 % of all scleroderma cases is caused by silicone prostheses.
- In the USA, the FDA (Food and Drug Administration) demands a register in which all persons who received a prosthesis are entered, in order to monitor them. But at this moment the observations are not convincing enough to deduce a harmful influence.
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| Solvents |
- Not a single epidemiological study has been performed to confirm the observations.
- The monomer (structure) of vinyl chloride could be responsible for connective tissue diseases.
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| Medications |
Prescription drugs mentioned may have other brand names
- Bleomycin, a therapeutic drug for cancer patients, has been held responsible for 2 cases of scleroderma.
- Anorexigenic products (to diminish appetite) have been held responsible for causing scleroderma.
- D-Penicillamine used to treat e.g. scleroderma is said to have only caused sclerodermatous skin reactions.
- Carbidopa + L5 OH Trytophan: (= an enzyme) only a few cases known.
- Pentazocine (Fortal*) provokes a local inflammatory reaction.
- Vitamin K1 is injected and has caused cutaneous sclerodermatous lesions (40 cases), but they disappeared after 12 to 18 months.
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| Cocaine |
By vasoconstriction (narrowing of the blood vessels) and endothelial (lining) lesions, plaques have been formed with the release of serotonin, which causes fibrosis.
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| Conclusion |
It seems that environmental factors may play a role in inducing scleroderma.
In some cases, hereditary material (the genes) is believed to protect the individual from these inducing environmental factors.
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