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In autoimmune skin diseases, the immune system targets the skin with an immune attack. Whereas the immune system is meant to function with a regard for the body’s tissues as “self” and outside invaders such as bacteria or viruses as “non-self,” in autoimmune skin disease the immune system is abnormally triggered against the “self” as if it were “non-self.”
Lupus and scleroderma are the autoimmune skin conditions that Dr. Sherber tends to see most frequently, but she sees patients with the full spectrum of autoimmune skin diseases and has conducted research in more rare conditions such as scleromyxedema.
Accurate diagnosis is critical for effective management of autoimmune skin diseases, and Dr. Sherber works closely with dermatopathologists, rheumatologists, and other specialists as needed to ensure thorough evaluation and comprehensive multidisciplinary care for each patient.
Scleroderma is a disorder that can take various forms: localized scleroderma (morphea), limited scleroderma (such as CREST syndome), and systemic sclerosis.
Dr. Sherber authored the skin chapter in the definitive textbook on scleroderma, now in second edition, and has cared for many patients with scleroderma.
In the various forms of scleroderma, tissues harden due to autoimmune activity targeting them.
Early signs can be subtle, and the cutting edge of treatment hinges on early diagnosis.
OUR APPROACH
Dr. Sherber works closely with rheumatologists and other specialists to ensure comprehensive care of her scleroderma patients, and often suggests that new patients with active disease have an evaluation at The Johns Hopkins Scleroderma Center with her colleague Dr. Fredrick Wigley.
Our staff can assist you in coordinating additional consultations, and will ensure that your records are shared with your medical team to give you seamless multidisciplinary care.
Active inflammatory stages of scleroderma must be treated thoroughly, and Dr. Sherber prescribes various topical or systemic approaches as needed, with every effort made to limit the use of steroids in order to prevent their long term effects.
RECOMMENDED TREATMENTS
Mat telangiectasias can be treated safely and effectively with the Nd:YAG laser.
Pronounced skin wrinkling and facial volume loss that can occur once disease becomes inactive can be treated with injectable dermal fillers such as Voluma.
Mineral sun protection, either with mineral-only formulations of sunscreen or with those that combine mineral and chemical sun filters, is emphasized in those with scleroderma because it will best prevent hyperpigmentation in areas of active inflammation.
Morphea, or localized Scleroderma, is a skin-limited condition in which autoimmune-mediated inflammations causes hardening of the skin.
It can occur in children and in adults and can become extensive in certain cases.
OUR APPROACH
Dr. Sherber focuses on topical therapy where appropriate. She endeavors to employ steroid-sparing strategies, such as treatment with topical calcineurin inhibitors or light therapy, when possible.
In certain cases, we may engage colleagues at the Johns Hopkins Scleroderma Center for additional specialized evaluations.
RECOMMENDED TREATMENTS
Micro-pulsed Nd:YAG Laser Genesis treatment is effective at fading Redness and purplish discoloration around inactive lesions, and can help to soften inactive lesions through deep heating of the dermis (the skin’s collagen layer).
Fractionated non-ablative laser treatments such as Perméa fade pigmentation left behind from active lesions and enhance absorption of topical treatments.
Mineral sun protection, either with mineral-only formulations of sunscreen or with those that combine mineral and chemical sun filters, is emphasized in those with morphea because it will best prevent hyperpigmentation in areas of active inflammation.
The diagnosis of lupus requires careful investigation, since signs and symptoms are often subtle and laboratory evaluations can be complex.
One in five women will have a positive ANA, which is a commonly used screening test, and so an accurate diagnosis hinges on context clues.
Dr. Sherber is expert at the most up to date screening techniques for diagnosing lupus, and treats the skin manifestations of systemic lupus as well as the forms of skin-limited conditions that fall under the family of lupus diseases.
OUR APPROACH
Dr. Sherber will spend time developing a thorough understanding of the history of your symptoms, as well as a complete list of medications since some forms of lupus are related to medication exposure.
Evaluation may include lab work and skin biopsies as needed.
Our trusted rheumatology colleagues may be consulted depending on your particular concerns.
For skin symptoms, topical or systemic approaches may be combined or tried individually, with an emphasis on limiting the use of steroids in order to avoid their long term effects.
Mineral sun protection, either with mineral-only formulations of sunscreen or with those that combine mineral and chemical sun filters, is emphasized in those with photosensitive forms of lupus since it blocks even visible light.
Dr. Sherber graduated magna cum laude from Harvard University, where she designed and implemented a novel degree program in health policy focused on assessing and improving quality of care. She next attended the Johns Hopkins University School of Medicine where she earned her M.D. degree. Following a post-doctoral fellowship in clinical research at Columbia University, she returned to Johns Hopkins for dermatology residency training and conducted research in scar healing and in disorders of abnormal collagen. She is now a Clinical Assistant Professor at George Washington University in the Department of Dermatology.
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