title: Juvenile scleroderma: experience in one institution.
abstract: BACKGROUND
  Scleroderma is a chronic connective tissue disease characterized by hardened or scaly skin and widespread abnormalities of the viscera, which is rare in the pediatric age group.
  
  
  OBJECTIVE
  In this study, we retrospectively reviewed 23 pediatric patients suffering systemic (SSc) and localized (LS) scleroderma.
  
  
  METHODS
  Twenty-three patients were enrolled and were diagnosed with SSc or LS from March 1993 to September 2009 in the Department of Pediatrics at Mackay Memorial Hospital in Taipei, Taiwan. These diagnoses were based on the criteria of the American College of Rheumatology and the clinical manifestations of hard skin. Data recorded included sex, age-at-onset, age-at-diagnosis, laboratory data, family history, trauma history, treatment, and outcomes.
  
  
  RESULTS
  Three patients suffered SSc and 20 patients had LS, including 16 girls and 7 boys. Mean age-at-onset was 6.55 +/- 3.28 years old. Antinuclear antibodies were positive in 15 patients. Tests for anti-Scl-70 antibodies were positive in 1 patient with SSc. One boy had en coup de sabre combined with a posterior fossa tumor. Twenty-two patients were treated with D-penicillamine. Oral prednisolone and methotrexate were added, if indicated. One girl with LS developed proteinuria after D-penicillamine treatment. All patients with localized disease ultimately documented a softening of their skin lesions.
  
  
  CONCLUSIONS
  While scleroderma is rare in children, the prognosis of SSc is poor but better than for adults. The prognosis for LS is usually benign, however, the skin may become progressively indurated and it may not only be a skin disease. No progression from LS to SSc was observed in our study.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chia-Yi
authors.initials: CY
authors.lastname: Lo
authors.forename: Shyh-Dar
authors.initials: SD
authors.lastname: Shyur
authors.forename: Szu-Hung
authors.initials: SH
authors.lastname: Chu
authors.forename: Li-Hsin
authors.initials: LH
authors.lastname: Huang
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Kao
authors.forename: Wei-Te
authors.initials: WT
authors.lastname: Lei
authors.forename: Chieh-Han
authors.initials: CH
authors.lastname: Cheng
authors.forename: Kuo-Hsi
authors.initials: KH
authors.lastname: Lee
authors.forename: Chen-Kuan
authors.initials: CK
authors.lastname: Chen
authors.forename: Ling-Chun
authors.initials: LC
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011507:Proteinuria; D011928:Raynaud Disease; D012189:Retrospective Studies; D012594:Scleroderma, Localized / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012737:Sex Factors; D013624:Taiwan