DEAR DR. DONOHUE: Would you discuss scleroderma? What are the early symptoms? Are there any tests to diagnose it? – E.W.

ANSWER: Scleroderma, or hard skin, isn’t a common disorder. In a metropolitan area the size of St. Louis, about 400 people have it. It strikes more women than men, and usually appears between the ages of 35 and 50.

One of the first signs of scleroderma is Raynaud’s phenomenon, an exaggerated response of the hands and feet to cold. When chilled, fingers and sometimes toes become startlingly white, and they hurt. They then turn blue, and finally red. The changes are due to forceful clamping of the arteries serving the fingers and toes. Only a few people with Raynaud’s develop scleroderma, but most scleroderma patients start out with Raynaud’s.

The skin of a scleroderma patient becomes thick and tight due to excessive deposition of collagen – a protein that’s found throughout the body to provide support to tissues. The skin can become so taut that fingers are drawn into a claw position and facial skin tightens so much that it is impossible to smile.

Body organs also can suffer from collagen deposition. Blood vessels, the digestive tract, the lungs, the kidneys and muscles are potential targets.

The result is a bewildering array of signs and symptoms. Swallowing can be most difficult; shortness of breath occurs with lung involvement; when kidneys are affected, blood pressure rises; muscles are often stiff and achy. This is scleroderma in its worst form. Some varieties of the illness are not as harsh.

Lab tests are most helpful in making the diagnosis. Since the immune system – the source of antibodies – is involved in this process, there are many unusual antibodies produced, and they can be detected in the blood.

The Scleroderma Foundation stands ready to help all patients with information on the latest developments in this illness. You can contact the foundation at 800-722-HOPE or on the Web at www.scleroderma.org.

DEAR DR. DONOHUE: What is your opinion on waiting until an infant is older to get the shots that are usually given early on? My daughter has a baby boy who is 4 months old. She wants to wait until the child is older to have him get his vaccines. – C.K.

ANSWER: Few medical interventions have benefited the public’s health as vaccines have. Let me give you a few examples: Smallpox has been eradicated from the planet. Polio is not a threat in developed countries anymore. I am sure people who had polio before the vaccine was available would tell you how they wished they lived at a time when everyone could be immunized. The incidence of measles and mumps has diminished by 99 percent.

Dedicated scientists develop the schedule for the optimum times for giving each vaccine based on when they will do the most good. I respect those scientists’ judgments, and I would be one of the first in line with an infant to have him or her immunized on schedule.

DEAR DR. DONOHUE: I was in Korea in 1952 and, on the way back to the states, I suffered a fractured skull. I cannot remember all that happened in Korea. It’s a blank. Should I try to find out what happened, or should I let the dog lie? – E.B.

ANSWER: Head trauma certainly can affect memory function, and a skull fracture inevitably has an impact on the brain.

I understand your curiosity about your Korean experience. Have you asked the Army if you could get a copy of your records, especially the medical records? I don’t know how long the Army keeps such records, but I would bet they are in storage somewhere. Why not go for it?

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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