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Photopheresis, also called extracorporeal photopheresis and photochemotherapy, is a form of immunotherapy that is used to treat skin problems associated with a certain type of cancer called cutaneous T-cell lymphoma. It is also being investigated as a treatment for other types of diseases including scleroderma.

In general, photopheresis is accomplished as follows:

• A portion of the patient's blood is removed through a vein.

• The white blood cells are exposed to ultraviolet A light (UVA) and treated with a drug called 8-methoxypsoralen.

• The blood is then returned to the patient's body through a vein.

The rationale for using photopheresis for the treatment of scleroderma is to attempt to increase the levels of an enzyme called collagenase which breaks down collagen and, thereby, slows down the rate of collagen production. This procedure is still considered experimental and further studies are required to prove the efficacy of photopheresis before it can be used as a standard treatment for scleroderma.

Autologous Stem Cell Transplantation

Stem cells are primitive blood forming cells found in the bone marrow and peripheral blood that eventually develop into mature red blood cells and white blood cells. Autologous stem cell transplantation is an experimental procedure that is being evaluated for the treatment of systemic scleroderma. This procedure involves first removing stem cells from a patient (either from the bone marrow or peripheral blood) and then storing the stem cells in a freezer until they are returned back to the patient. Once the stem cells have been removed and stored, the patient's own immune system is suppressed using powerful drugs know as immunosuppressants. The stored stem cells are then thawed and returned back into the patient by intravenous infusion. Essentially, this treatment is designed to reverse the "autoimmunity" which is thought to be the primary mechanism responsible for the overproduction of collagen that is characteristic for scleroderma. Although autologous stem cell transplantation has been found to slow down or improve the course of severe systemic scleroderma in some patients, it is still considered an experimental treatment and is also associated with a high mortality rate of about 10%.