SCLERODERMA AND THE CARCINOID-SYNDROME

The follow up of a case of the carcinoid syndrome complicated by scleroderma is reported, in which progress of the disease may have been halted by treatment with a combination of cyproheptadine, parachlorophenylalanine and prednisolone. Impairment of tryptophan and 5-hydroxytryptamine (serotonin) metabolism appears central to the development of skin fibrosis in the carcinoid syndrome and may be indicative of important mechanisms in the pathogenesis of idiopathic scleroderma. The association of scleroderma and metastatic carcinoid tumour is rare, but well recognized. Acrosclerosis, Raynaud's phenomenon and visceral involvement are characteristically absent. The development of cutaneous sclerosis has been an indicator of poor prognosis; death occurred within 2 years of diagnosis in all of the four previously reported cases.