Consultant Physiotherapist Will Gregory

Keep up the exercises – but forget the wax bath, study suggests

Hand problems are often one of the first symptoms of the connective tissue disease scleroderma.

Nine out of 10 people with the condition experience musculoskeletal problems, including skin thickening and tightening.

Now a new research study involving patients at Salford Royal has shown that exercises can help improve hand movement for these patients – while the warm wax baths that are sometimes recommended didn’t show any significant benefit.

Consultant Physiotherapist Will Gregory led the study, one of very few to be carried out on rehabilitation in scleroderma (also known as systemic sclerosis).

He explained: “In people with scleroderma, skin thickening can really limit hand movement , impact on daily life and cause them pain. It can make it difficult to do up buttons, give or accept change in shops and do normal jobs in the kitchen, for instance.

“From our involvement with a patient support group, we know that this is an important issue.

“Wax bath treatment, where the patient dips their hand into medical-grade warm paraffin wax then wraps it in plastic bag and a towel to keep it warm for 10 minutes, is a treatment that has been in use for many years. It was previously possible to get the wax on prescription and patients can buy their own wax bath relatively cheaply.

“But there isn’t a lot of evidence from research to show that the treatment works, which is why we were delighted to be supported by the health charity Scleroderma and Raynaud’s UK to test it.”

The study compared two groups of scleroderma patients at Salford Royal, with one group using a wax bath four times a week in their own homes in addition to daily stretching exercises and the other group just doing the daily exercises. They all kept diaries to record their levels of pain, check their ability to do the exercises and wax treatments regularly and see if they had been able to reduce any of their pain relief medications.

Altogether 34 patients took part in the study over nine weeks, with further assessments of their hand movements, strength and abilities in day to day tasks at 18 weeks.

Mr Gregory said: “While our results confirmed that wax bath is a safe treatment that some patients like, there wasn’t a significant improvement in their symptoms so it isn’t something that we can recommend prescribing.

“However, there was an improvement in hand mobility associated with the daily home exercises so the study reinforces our current recommendations. This is good news for people who can’t use a wax bath, perhaps because they have ulcers on their fingers or are allergic to the wax, who can now be reassured that the exercises alone will help.”

The study ‘A randomised controlled trial of wax baths as an additive therapy to hand exercises in patients with systemic sclerosis’ was sponsored by Salford Royal NHS Foundation Trust, funded by Scleroderma and Raynaud’s UK and has now been published in the journal Physiotherapy.