14 Most Common Symptoms of Scleroderma

2. Cold Fingers or Toes That Turn Red, White, or Blue

You may notice your fingers or toes change color when you feel cold or stressed. This symptom, called Raynaud’s phenomenon, is very common in people with scleroderma. During an episode, your skin often turns white first because small blood vessels tighten and reduce blood flow. The area may then turn blue as oxygen levels drop.

As blood flow returns, your skin can turn red. You may feel throbbing, tingling, or burning at this stage. Some people also notice numbness or swelling. Color changes usually affect the fingers and toes, but can also affect the nose or ears.

Episodes may last from a few minutes to over an hour. If episodes happen often, the skin can become dry or cracked. In severe cases, sores may form on the fingertips or toes due to poor blood flow. Treatment may include vasodilators to relax your blood vessels and improve circulation.

3. Ulcers or Sores on Fingertips

You may notice small open sores on your fingertips or around your nails. These sores, called digital ulcers, can look like small craters in the skin and may take a long time to heal. Scleroderma often narrows and tightens your blood vessels, which limits blood flow to your fingers. When blood flow drops, the skin does not get enough oxygen, and tissue can break down.

Raynaud’s attacks, cold weather, or even minor bumps can trigger a sore. Once the skin opens, the sore can become infected. You may see pus, feel throbbing pain, or notice more redness and swelling. Treatment focuses on improving blood flow and protecting the wound. Vasodilators may be used to widen blood vessels, while antibiotics may be needed if infection develops.

Pain relievers can help manage discomfort when it interferes with daily activities. You can lower your risk by keeping your hands warm, avoiding smoking, and protecting your fingers from injury. Wearing well‑fitting gloves and moisturizing dry skin also helps reduce cracks that can turn into sores.

4. Small, Red Spots on the Face and Chest

You may notice small red spots on your face, chest, or hands. These spots often look like tiny red dots or thin red lines that spread out like a web. They are called telangiectasias and form when tiny blood vessels under your skin widen and stay open.

In scleroderma, changes in your blood vessels can cause this problem. The spots usually do not hurt, but they can become more visible over time. You may see them most often on your cheeks, around your nose, on your lips, and across your upper chest.

Some people also notice them on their hands. They tend to stand out more if you have lighter skin, but they can appear on any skin tone. Common features include small red or pink dots and flat marks that do not fade when you press on them. You may also notice clusters of these spots that slowly increase in number over time. These spots are not a rash and do not spread like an infection.

5. Puffy or Swollen or Painful Fingers and/or Toes

You may notice that your fingers or toes look puffy or swollen and feel tight, stiff, or sore, especially in the morning. Rings or shoes may feel tighter than usual. Swelling often happens because fluid builds up in the soft tissues.

In scleroderma, changes in your blood vessels and skin can make this worse, which make the skin look shiny or stretched. You might also feel pain, numbness, or a pins-and-needles feeling. Cold weather or stress can reduce blood flow to your fingers and toes.

This can make them change color, feel cold, or become painful. For some people, swelling comes and goes. For others, it lasts longer and may lead to thickened skin over time. If swelling becomes severe, treatment may include medications that help relax blood vessels or reduce inflammation.

6. Painful or Swollen Joints

You may notice pain, stiffness, or swelling in your joints as scleroderma develops. This symptom can affect your hands, wrists, knees, ankles, or elbows, and the discomfort may start slowly and worsen over time. Joint pain often feels worse in the morning or after you rest.

Your fingers may feel tight and hard to bend, while swelling can make your joints look puffy and feel warm or tender. Scleroderma can cause your immune system to stay overactive, which leads to inflammation in the lining of your joints.

When this happens, you may struggle with simple tasks like buttoning a shirt or holding a cup. You might also feel stiffness that lasts for more than 30 minutes after you wake up. Some people develop joint contractures, which means the joints become stuck in a bent position. Tight skin over the joints can make movement even more difficult.

7. Muscle Weakness

You may notice muscle weakness as scleroderma affects deeper tissues. Your immune system can cause inflammation in the muscles, which makes them feel tired and less strong. This problem can develop slowly and become more clear over time.

Weak muscles can make daily tasks harder. You might struggle to lift groceries, climb stairs, or rise from a chair. Some people feel weakness in their shoulders and hips first, while others notice it in their hands or legs. Muscle weakness often comes with muscle pain or stiffness.

When your skin tightens and joints become stiff, your muscles may not move as freely. This limited movement can reduce strength if it continues for a long time. In some cases, muscle weakness links to overlapping conditions that affect connective tissue, which can lead to ongoing muscle inflammation.

8. Damage to Internal Organs

Systemic scleroderma can affect more than your skin. It may harm your internal organs when excess collagen builds up inside your body. Your lungs are frequently affected. You may notice shortness of breath, a dry cough, or trouble with physical activity. Scar tissue in the lungs can make it harder for oxygen to move into your blood.

Your heart can also be affected. You might feel chest pain, irregular heartbeats, or swelling in your legs. Damage to blood vessels can raise blood pressure and strain your heart over time. Scleroderma may involve your kidneys. High blood pressure can appear suddenly and become severe.

If untreated, kidney damage can reduce your body’s ability to remove waste from the blood. Your digestive system is another common target. You may have acid reflux, trouble swallowing, bloating, or constipation, as thickened tissue can slow the movement of food through your stomach and intestines.

9. Systemic Scleroderma

Systemic scleroderma, also called systemic sclerosis, affects more than just your skin. This form can involve your blood vessels and internal organs and often leads to wider and more serious symptoms than localized types. You may first notice thick, tight skin on your fingers or hands. The skin can look shiny and feel stiff. Over time, this tightness can limit how well you move your fingers, wrists, or other joints. This type of scleroderma can also affect how your blood flows.

Many people develop Raynaud’s phenomenon, which causes your fingers or toes to turn white or blue in cold weather or stress. You may feel numbness, tingling, or pain during these episodes. Internal organs can also become involved. Your digestive system may slow down, which leads to heartburn, trouble swallowing, bloating, or constipation. If your lungs are affected, you might notice shortness of breath or a dry cough.

10. Difficulty Swallowing

Difficulty swallowing, or dysphagia, often occurs in systemic scleroderma because the disease affects the muscles and tissues of your esophagus. You may feel like food moves slowly down your throat or gets stuck in your chest. Scleroderma can make the esophagus stiff and weak, so it cannot push food downward smoothly.

You might cough, choke, or need to drink a lot of water to help food go down. Some people also notice heartburn or a burning feeling in the chest. Trouble with solid foods may appear first, and over time, even soft foods or liquids can become hard to swallow. Eating may take longer than usual, and you may avoid certain foods because they feel uncomfortable.

Other signs linked to swallowing problems include food coming back up into your throat and feeling full after only a few bites. Unplanned weight loss can also occur as eating becomes more difficult. Treatment may include acid-reducing medications and drugs that help improve movement in the digestive tract. In some cases, therapy helps you learn safer ways to swallow.

11. Cramps, Bloating, and Diarrhea

Scleroderma affects your digestive tract, especially your small and large intestines, and may cause cramps, bloating, and frequent diarrhea. Cramps usually feel like a squeezing or sharp pain in your lower belly, which you may feel after eating or at random times during the day.

Bloating is common, and you may feel full even if you eat a small meal. Your abdomen might look swollen or feel tight because scleroderma slows the movement of food and gas through your intestines. Diarrhea may occur when your body cannot absorb nutrients well, which leads to loose stools several times a day.

In some cases, you may also notice urgency, meaning you need to use the bathroom quickly. Treatment may include medications that help control inflammation or regulate immune activity, or improve movement in the digestive tract.

12. Localized Scleroderma

Localized scleroderma mainly affects your skin and causes areas of skin to become thick, hard, and tight. These patches may look shiny and feel firm when you touch them. This type usually stays limited to one area or a few areas of your body and does not affect your internal organs.

Many people develop it before age 40, and women get it more often than men. You may notice oval or round patches called morphea, which can start as reddish or purple areas and then turn thick and pale in the center. Over time, the skin may darken or lighten compared to the surrounding area.

Another form can cause long streaks of hardened skin, often appearing on your arms, legs, or forehead. In children, this pattern can affect growth in the area involved. Localized scleroderma can sometimes improve on its own, but the skin changes may last for years.

13. Malnutrition

Scleroderma can cause malnutrition when it affects your digestive system by tightening and scarring the esophagus, stomach, or intestines, which makes it hard for your body to move and absorb food properly. You may eat enough, but your body may not take in the nutrients it needs. Swallowing problems often appear first, and you might feel food sticking in your throat or chest.

Ongoing heartburn and acid reflux can also reduce your desire to eat. When your intestines do not work well, you may notice ongoing bloating, diarrhea or constipation, unplanned weight loss, and weakness or fatigue.

Poor absorption of nutrients can lead to low levels of iron, vitamins, and protein, which causes anemia, muscle loss, and thinning hair. Over time, you may lose body weight without trying. Scleroderma can damage tissues in your mouth, making chewing and swallowing harder, and tooth problems may also limit the types of food you feel able to eat.

14. Risk Factors

Scleroderma can affect anyone, but certain factors increase your risk. Your sex plays a role, as women develop scleroderma more often than men. The exact reason is not fully understood, but hormones and immune system differences may contribute. Your age also matters. The disease most often appears between ages 30 and 50. Localized forms may start before age 40, while systemic forms often develop in adults during midlife.

Your race can influence both the risk and severity of certain conditions. African Americans have a higher risk of systemic scleroderma and may experience more serious organ involvement. However, people of any race or ethnic group can develop the condition.

Family history may increase your risk. If a close relative has an autoimmune disease, your immune system may be more likely to react in abnormal ways. Certain genes can make you more prone to scleroderma.

Environmental exposure may also contribute. Contact with certain chemicals, such as silica dust or industrial solvents, increases risk in some people. These exposures may trigger immune changes in those who are already vulnerable.