Occupationally-induced scleroderma

Systemic sclerosis or scleroderma is an uncommon multisystem disease with a reported incidence of 2 to 12 cases per million people per year. The clinical and pathological features can be grouped into three main categories: those related to fibrosis, to vascular abnormalities, and to immunological abnormalities. Cutaneous features dominate the patients' appearance, and Raynaud's phenomenon is an early symptom. A possible association between scleroderma and workers exposed to hand-arm vibration and/or silica has been suggested by reports in the literature since the turn of the century. A further four patients with collagen disease are reported here. Three were occupationally exposed to both hand-arm vibration and silica, the fourth to hand-arm vibration alone. In conjunction with previously reported cases, this supports the hypothesis that collagen disease may be work attributable in hypersusceptible persons.