Exposure to certain drugs can result in a scleroderma-like condition that usually is reversible upon discontinuation of the exposure.
Diagnostic features:
(1) absence of clinical features prior to exposure to a drug
(2) development of clinical and laboratory features following exposure to an implicated drug
(3) disappearance of clinical features after discontinuation of the exposure. Ideally a drug rechallenge is attempted to see if findings reappear but this is usually not performed.
(4) exclusion of other diagnoses that can explain the findings better
Clinical features:
(1) sclerodermatous patches
(2) poikiloderma
(3) acral sclerosis
(4) Raynaud's phenomenon
(5) eosinophilia-myalgia (with L-tryptophan)
Laboratory features may include:
(1) anti-nuclear antibody (ANA) positivity
(2) other autoantibodies (anti-Scl-70, other)
Implicated drugs::
(1) L-tryptophan
(2) bleomycin
(3) fosinopril (an ACE inhibitor)
Other conditions to exclude:
(1) systemic sclerosis
(2) occupational scleroderma from vinly chloride or other chemical exposure (see above)
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