Sjogrens syndrome and dry itchy skin

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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From the American College of Rheumatology, the National Institutes of Health, and the Arthritis Foundation

“Sjogren’s” can refer to either the syndrome or the disease. The syndrome is a condition in which the eyes and mouth become excessively dry.

This may occur as a result of many different conditions.

Sjogren’s disease, on the other hand, is a specific autoimmune disease that has many of the same features of its close cousin, systemic lupus erythematosus.

The distinction is more than an academic one because the syndrome can be treated with either elimination of the cause of the syndrome (such as medication) and symptomatic therapies. The disease is a potentially serious problem that may require immunosuppressive therapy. The signs and symptoms, of Sjogren's syndrome vary from person to person. These signs and symptoms are discussed below:

The most common feature of Sjogren's syndrome is dry eyes. The dry eyes can appear red and can cause a feeling of burning and itchiness. The dry eyes can also cause a gritty feeling, as if something foreign is under the eyelid, such as sand. The eyelids may feel stuck together and the eyes may be sensitive to light. Blurry vision can result as well. Ulcers of the cornea can also occur. In the worst case scenario, Sjogren's syndrome can cause blindness.

A dry mouth (technically known as xerostomia) is the other major feature associated with Sjogren's syndrome. The lack of saliva in the mouth can lead to difficulty swallowing, chewing, and eating because the food sticks to the tissues. A lack of saliva can also cause tooth decay because saliva contains substances that normally helps rid the mouth of bacteria.

Recurring mouth infections, such as bacteria infections, virus infections, or fungus infections can occur due to the lack of saliva. One of the most commonly seen fungal infections in Sjogren's syndrome is known as thrush or candidiasis, a yeast infection. Candidiasis appears in the mouth as white patches that can be scraped off. Candidiasis can also present as red, burning areas in the mouth. Mouth infections are treated with the appropriate antibacterial, anti-viral, or anti-fungal medications.

Dry mouth can cause a burning sensation in the mouth and throat. A lack of saliva can also lead to a loss of taste and smell.

About half of people with Sjogren's syndrome have dry skin. Some people only experience itching, but the itching can be severe. Scratching itchy skin can cause the skin to break open, leading to infection. Some people develop cracks and splits in their skin that can become infected easily.

Sjogren's syndrome can also cause a dryness in other body areas that need moisture such as the nose, airways, throat, digestive tract, sinuses, and vagina.

Mucous membranes become dry in Sjogren's syndrome. Nosebleeds can also occur in Sjogren's syndrome.

Sjogren's syndrome is also known to cause fatigue that can sometimes lead to exhaustion. Joint pain can also occur due to inflammation. A low-grade fever can also occur in people with Sjogren's syndrome.

Sjogren's syndrome can cause tissue damage and inflammation to major organs in the body, such as the stomach, thyroid, intestines, pancreas, and lungs.

Many people with Sjogren's syndrome have thyroid disease. The thyroid can be overactive (known as Grave's disease) or underactive (known as Hashimoto's disease).

The lungs can be affected by a dry mouth. People with dry mouth may not have enough saliva to swallow food. This can cause the food to get stuck in the lungs and can result in pneumonia.

Another cause of pneumonia is when bacteria gets into the lungs and coughing does not remove it. This can happen to people with Sjogren's syndrome because there may not be enough mucus produced in the lungs to remove the bacteria.

If the lungs or lining of the lungs are inflamed, shortness of breath can result. Lung problems can be due to pneumonia, but can also be due to bronchitis, tracheobronchitis, or laryngotracheobronchitis.

The digestive system can also become inflamed in Sjogren's syndrome. For example, inflammation of the esophagus can cause difficulty swallowing. Inflammation of the digestive system can also cause heartburn.

Inflammation of the digestive system can cause diarrhea, loss of appetite, and weight loss.

Inflammation of the kidneys, a condition known as interstitial nephritis, is the most common kidney problem in Sjogren's syndrome.

Some people with Sjogren's syndrome develop renal tubular acidosis. This condition causes a decrease in potassium in the blood. Potassium is very important for normal bodily functioning and a decrease of this element can affect the heart, nerves, and muscles.

Some people with Sjogren's syndrome develop hepatitis, which is inflammation of the liver. Some people with Sjogren's syndrome develop cirrhosis, which is a type of disease that hardens and destroys the liver.

A type of cirrhosis that some people with Sjogren's syndrome have is known as primary biliary cirrhosis (also known as PBC). PBC is a type of cirrhosis caused by disease to the bile ducts. Bile ducts are tubes that allow bile to flow through it. Some symptoms of PBC are fatigue and itchiness.

About 5% of people with Sjogren's syndrome have lymphoma. Lymphoma is cancer of the lymphatic tissue. When lymphoma develops in people with Sjogren's syndrome, it often involves the salivary glands, which causes them to enlarge. Itchiness can occur with lymphoma.

A small tissue sample of tiny salivary glands from the inside of the lower lip can be performed to look for abnormalities. The tissue sample is examined under a microscope. If inflammation and a particular pattern of lymphocytes are found in the tissue sample during this examination (types of white blood cells), the test is positive for Sjogren's syndrome. This test is the best way to tell if a dry mouth is caused by Sjogren's syndrome. If this test is positive and the patient has a dry mouth and dry eyes, the patient is generally considered to have Sjogren's syndrome. Nevertheless, the doctor may do additional tests to determine what other parts of the body have been affected.

Blood tests can be performed to determine the presence of antibodies formed in response to two antigens known as Ro and La. The antibodies to Ro are known as anti-Ro (also known as SS-A or SS-Ro). The antibodies to La are known as anti-La (also known as SS-B or SS-La). Together, these antibodies are known as Sjogren's antibodies. The presence of these antibodies in pregnant women can cause a rash in the infant that goes away in a few months. In rare cases, these antibodies are associated with heart problems in the newborn.

There is also artificial saliva that people with dry mouth can use. Artificial saliva is most useful for people that produce very little saliva or none at all. Some artificial salivas contain fluoride, which helps prevent cavities. Salivart, a type of artificial saliva, comes in a spray can and is easy to use. The problem with all artificial salivas is that they all work for a limited time, since they are eventually swallowed. Artificial saliva can last as long as two hours. Those that contain gel in it tend to provide the longest relief.

The doctor may prescribe Salagen (pilocarpine hydrochloride) to treat dry mouth, because this medication increases the production of saliva. Salagen can cause increased sweating and headaches. Another medication given for dry mouth is Exovac (also known as Cevimeline). Exovac causes certain glands in the mouth to produce more saliva. Exovac also has side effects associated with it, such as sweating, runny/stuffy nose, and nausea. It can less commonly cause itching, difficulty breathing, and fast breathing. Occurrence of any of these less common side effects should lead one to call the doctor immediately. The effects of Salagen and Exovac lasts for a few hours. The products can be used three to four times a day.

Medications that increase saliva and mucus can decrease dryness in the nose and throat. Dried and/or cracked lips can be treated with lip balm or lipstick that contains oils or petroleum jelly (such as Vaseline). For mouth pain, the doctor can prescribe a mouth rinse that contains medication to control pain and inflammation. The doctor can also prescribe a gel or ointment to rub on sore areas to control pain and inflammation.

Using heavy moisture creams and ointments when the skin is still damp can help trap moisture and can improve dry skin. Such creams are usually used about three to four times a day. Lotions, which are not as heavy as creams or ointments, are usually not recommended because they evaporate fast, a process that can cause dry skin.

People with dry skin are usually recommended by their doctor to avoid washing with hot water and to avoid soaking the hands in water or using cleaning solutions. Short showers of less than 5 minutes are generally recommended. Moisturizing soaps can be helpful to clean oneself with. Patting the skin, instead of rubbing it, can be helpful. After patting the skin down is when the moisturizing creams should be used.

For people that take baths, staying in the tub for 10 to 15 minutes is generally recommended because it gives the body a chance to absorb moisture. Rubber gloves should be used when doing dishes or housecleaning. The doctor can help someone with Sjogren's syndrome avoid medications that can decrease body fluids.

Avoiding smoking or exposure to smoke can be helpful to people with Sjogren's syndrome because smoke increases dryness. Avoiding windy, breezy, and drafty environments can also help one reduce dryness. Avoiding prolonged sun exposure and use of sunscreen (at least SPF 15) when going outdoors is generally recommended because many people with Sjogren's syndrome (especially those with lupus) get painful burns even with a small amount of sun exposure.

Use of a humidifier in the bedroom can help moisten the skin. Regarding makeup, it is advised by many doctors to only apply mascara to the tips of the eyelashes so that it does not get in the eyes. Also, eye shadow or eyeliner is often recommended to be placed on the skin above the eyelashes as opposed to the sensitive skin under the eyelashes that is close to the eyes.

Dryness on the outer part of the vagina can be treated with skin creams and ointments. Due to the risk of not being able to have sexual intercourse without pain because of a dry vagina, a moisturizer can be used inside the vagina to make it wet. This, in turn, would make sex more comfortable. Lubricants, as opposed to moisturizers, do not help the vagina retain moisture. This is why doctors recommend lubricants for sexual intercourse only. There are different types of lubricants. Lubricants that contain oil, such as petroleum jelly, trap moisture, but can cause sores and can interfere with the natural cleaning process of the vagina. Lubricants that dissolve in water are generally better to use.

Steroid medications in various forms (such as pills or creams) are also used to treat pain and itchiness associated with Sjogren's syndrome because they decrease inflammation.

Corticosteroids are sometimes used to decrease inflammation of the windpipe, voice box, bronchial tubes, and the lining of the lungs. Bronchial tubes are airways that connect that windpipe to the lungs. If the bronchial tubes have become narrowed, making it difficult to breath, medications are available that can widen them. A humidifier can also help make it breath easier.

The problem with corticosteroids is that they can become less effective and cause serious side effects when used for months or years. This is why doctors usually prescribe corticosteroids to treat suddenly occurring symptoms, with the goal of slowly taking the patient off the medication.

An anti-malaria medication, Plaquenil (also known as hydroxychloroquine), is sometimes used to treat Sjogren's syndrome because it seems to decrease tissue damage of the joints, skin, and other organs of the body. However, it is not very good at treating the dryness associated with Sjogren's syndrome.

In severe cases, drugs that decrease the response of the immune system are sometimes used. These drugs are known as immunosuppressive drugs. Examples of immunosuppressive drugs include hydroxychloroquine (Plaquenil), methotrexate, azathioprine (Imuran) and cyclophosphamide (Cytoxan). These drugs are most likely to be used if there are problems with the kidneys, blood vessels, nerves, brain, or spine.

If pneumonia develops, this is treated with various types of antibiotics (medications that kill bacteria) depending on the person and type of infection.

Sjogren's syndrome is generally not a life-threatening condition. The signs and symptoms are generally more annoying than severe and thus the outlook for most people is good. The dryness may last for the rest of the person's life, however. In addition, some individuals with Sjogren's syndrome do have severe signs and symptoms of this condition.

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