Rheumatology and Dermatology

Most rheumatologic diseases involve multiple body systems. If you have any rheumatologic condition, which generally involves the joints, muscles, or ligaments, you may also experience skin involvement. Mount Sinai is one of a growing number of health care systems that have dermatologists and rheumatologists working together to provide the best possible care and treatment. We have just launched an innovative “Dermatology Service to Treat Systemic Diseases” which is run by Dr. Saakshi Khattri, who is board certified in both rheumatology and dermatology. The National Institutes of Health has found that patients benefit when rheumatologists and dermatologists take a team approach to these conditions, both to improve care and to help with early detection.

In general, if you have skin involvement in your rheumatology condition, we recommend that you limit your exposure to the sun. Less exposure to the sun may lead to a vitamin D deficiency. We can help you address that. Our goal is to give you the best possible quality of life.

Conditions We Treat

Many of these conditions are autoimmune diseases, in which your immune system is tricked into attacking your own body. The rheumatic skin conditions that we see most often are:

• Psoriasis causes red, scaly patches on the skin. Almost 30 percent of the people with psoriasis also get psoriatic arthritis, or inflamed joints. We treat psoriasis with topical therapies and, if necessary, biologic medications. As a patient at Mount Sinai, you may also have the opportunity to participate in state-of-the-art clinical trials, if appropriate.
• Dermatomyositis causes your skin and muscles to become inflamed, resulting in a rash and muscle fatigue. It is an autoimmune disease that can make it difficult to swallow or breathe and can lead to calcium deposits in your skin. The condition can last for anywhere from a few months to several years. We treat dermatomyositis with systemic immunosuppressants.
• Lupus is an autoimmune disease that can affect many body systems, including the skin. Lupus can cause fatigue; painful or swollen joints; headaches; low-grade fever; and light sensitivity. Any organ system can be involved. While we cannot cure lupus, we use medications to manage the disease so you can live a full life.
• Morphea or localized sclerosis can cause painless light or purple patches on your skin. You may find your skin gradually becomes thicker and drier. This condition often lasts for years, and may leave scars. We treat it with topical medications, UV light, and oral medications. We know this condition can cause psychological distress and we are here to help.
• Systemic sclerosis is an autoimmune disorder that affects your skin as well as your esophagus, lungs, heart, and kidneys. We do not know exactly what causes systemic sclerosis. If you have this condition, you may experience calcium bumps on your fingers and other bony areas, joint pain, spider veins, heartburn and difficulty swallowing, kidney disease, and heart failure. We cannot cure systemic sclerosis, but we can manage your symptoms. At Mount Sinai, we are researching use of targeted therapeutics to treat the condition.
• Vasculitis causes your blood vessels to become inflamed. It can restrict blood flow, which can hurt your skin and internal organs. Vasculitis can cause fever, headache, fatigue, weight loss, night sweats, and rash. We do not know exactly what causes the condition, but possible triggers include certain infections and blood cancers, and some medications. We generally treat vasculitis with medications in two stages. First, we stop the inflammation; then we provide ongoing maintenance to prevent relapse.

Treatments We Offer

Depending on the condition and its severity, we offer a variety of types of treatment. In general, we use oral prescription medications to treat rheumatic skin disease.

Most patients with rheumatic skin conditions should also take into account these issues:

• Developing a sun protection plan (especially for lupus and dermatomyositis patients)
• Protecting your skin from the cold (particularly for patients with systemic sclerosis and Raynaud’s phenomenon (a condition that causes numbness in fingers and toes)
• Ensuring adequate levels of vitamin D
• Recommending skin care products that are less likely to irritate your skin

Many rheumatic skin conditions are not curable, so managing symptoms is key. We are aware of the physical difficulties and emotional frustrations that you may experience. Our goal is always to maximize your quality of life.

Why Mount Sinai

Rheumatic dermatology is a relatively new field. Mount Sinai stands ahead of the pack by enabling rheumatologists and dermatologists to work together to treat these conditions. This approach is more effective than the traditional way of addressing these conditions—and offers an improved quality of life.