Background: Scleroderma is an autoimmune condition in which collagen deposits in abnormally high concentration in the subcutaneous tissue and other areas of the body. In some cases, this restricts blood supply to the skin and prevents normal wound healing. Wounds fester and become infected, decreasing oxygen delivery even further. Hyperbaric oxygen delivers oxygen to ischemic, marginal wounds and is known to accelerate wound healing by as much as 50%. Additionally, hyperbaric oxygen is an immunomodulator, which decreases the production of ICAM and Tumor Necrosis Factor alpha by vascular endothelial cells and neutrophils (Refs 1,2,3,4,5).
Study Design: A 50 year-old white female ceramic artist with diffuse scleroderma for 10 years was referred to our Institution for evaluation of more than 10 open wounds in both her upper extremities, present for at least 6 months, and refractory to every conventional therapy.
A 46 year-old white male trumpet player with cutaneous scleroderma for 7 years was referred to our Institution for symptoms of Raynaud and ulcers on his fingertips lasting the entire winter season, associated with numbness in his fingers on both hands.
Each patient was given 50 consecutive 90 min. sessions of Hyperbaric Oxygen with a mild hyperbaric chamber at 1.3 ATA.
Results: In both cases, initial oxygen saturation readings were not obtainable in any of the fingers, which were pale and insensate. Both patients had 5 to 10 episodes of Raynaud per day. No change was observed during the first 10 treatments. After the 20th, it was observed that the episodes of Raynaud, which had been decreasing, had completely abated. Oxygen saturation readings became obtainable and improved slowly. At 30 treatments, both patients showed definite evidence of healing their wounds. Additionally, sensation returned to the tip of their fingers. At 40 treatments, their pulse oximetry readings were consistently 98% in all fingers, and there was a dramatic progress in wound healing. Therapy was stopped at 50 sessions. Approximately a year after hyperbaric oxygen therapy was discontinued, wounds remained healed and pulse oximetry readings continued to be 98%, suggesting that new capillary growth had been permanently achieved. New wounds did not get infected and healed rapidly. Though before their treatments, both patients had experienced a slow progression of their disease, no new symptoms had appeared. In fact, there appeared to be a regression in the amount of deposited collagen.
Conclusions: Although scleroderma is not an approved indication for hyperbaric oxygen therapy, the ischemia it causes can be combated by hyperbaric oxygen. The diffusion of oxygen in areas of the body, ischemic because of scleroderma, may change the number and distribution of capillaries in these areas, thus allowing healing. Additionally, hyperbaric oxygen may ameliorate this debilitating chronic autoimmune condition.
References:
- Buras JA, Stahl GL, Svoboda KK, Reenstra WR. Hyperbaric oxygen downregulates ICAM-1 expression induced by hypoxia and hypoglycemia: the role of NOS. Am. J. Cell. Physiol. 2000 Feb;278(2):C292-302.
- Hong JP, Kwon H, Chung YK, Jung SH. The effect of hyperbaric oxygen on ischemia-reperfusion injury: an experimental study in a rat musculocutaneous flap. Ann. Plast. Surg. 2003 Nov;51(5):478-487.
- Yamashita M, Yamashita M. Hyperbaric oxygen treatment attenuates cytokine induction after massive hemorrhage. Am. J. Physiol. Endocrinol. Metab. 278:E811-E816, 2000.
- Wallace DJ, Silverman S, Goldstein J, Hughes D. Use of hyperbaric oxygen in rheumatic diseases: case report and critical analysis. Lupus 1995 Jun;4(3):172-175.
- Thom SR, Mendiguren I, Hardy K, et al. Inhibition of human neutrophil beta2 integrin-dependent adherence by hyperbaric O2. Am J Physiol. 1997;272(3 Pt 1):C770-777.
