By Paul G. Donohue M.D. January 24, 2011 12:00 AM

DEAR DR. DONOHUE: can you help me? My nephew has what they call scleroderma. It’s very painful. where does it come from? any cure?

“Scleroderma” (SKLAIR-uh-DUR-muh) literally translated from Greek means “hard skin.” It’s due to an overproduction of collagen, one of the body’s main building materials. the excessive production appears to come from an immune attack that shifts the manufacturing of this tough, fibrous substance into high gear. Skin thickens and hardens to such a degree that bending the fingers can be all but impossible. the face freezes into an immobile mask, unable to smile or frown.

Internal organs suffer the same fate. the kidneys are a frequent target, and, when affected, raise blood pressure and eventually fail. the lungs, heart, blood vessels and digestive tract all can be involved. It’s not surprising that scleroderma has many symptoms that depend on which organs are infiltrated with collagen.

Not every scleroderma patient experiences involvement of all the organs I mentioned. I don’t know the extent of your nephew’s involvement. No cure medicine exists. Many control medicines do, and the current outlook for scleroderma patients is much brighter than it was only a few decades ago. High blood pressure and kidney failure formerly were the principal causes of death. Today, with medicines called ACE inhibitors, the blood pressure-kidney problems are controllable.

Medicines that rein in the immune system are another step in conquering this illness. Cyclophosphamide is one example. and medicines that are directed at assisting organs damaged by collagen also are available.

You and your nephew ought to contact the Scleroderma Foundation at 800-722-HOPE or at its website, scleroderma.org. You’ll find it a source of valuable information, and your nephew will realize he is not battling this illness alone.

DEAR DR. DONOHUE: please explain what a leaky heart valve is, what causes it and what the treatment is. I am 82.

Each of the four heart chambers comes equipped with a valve. When blood passes through a chamber, its valve closes so that blood doesn’t leak back into it. the valves keep blood moving in the right direction through and out of the heart. When a valve develops a leak, some blood flows back into the chamber it just left. less blood is pumped, therefore, with each heartbeat. Symptoms arise depending on the amount of blood that flows backward. If the leak is slight, no symptoms develop and nothing is done. If it’s large, people become breathless when they are active. Medicines can restore a better output of blood pumped from of the heart. the ultimate solution is replacement of the leaking valve. Rheumatic fever is one cause of leaking valves.

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