Patient: frequent infections and atrophy of the fingers and thinning of the skin. The onset of scleroderma has been nearly 20 years now, and the onset of interstitial pneumonia has been nearly 4 years. He has been taking Chinese medicine and his condition is still worsening. In September this year, I was hospitalized for the recurrence of interstitial pneumonia, which has been controlled. Now the Chinese medicine has been stopped and now I have been using methylprednisolone for more than a month (reduced from 32 mg to 16 mg so far. Now the doctor is ready to give me cyclophosphamide again. I have an infection in my finger, so if I use cyclophosphamide, will it make the infection worse? Are there any immunosuppressants that have less side effects now? Are there any new treatments? There are immunosuppressants with fewer side effects, but they are not as effective as cyclophosphamide for interstitial pneumonia. Patient: Thank you, Dr. Wang, for your advice. I still want to ask two questions: 1. If the interstitial pneumonia is controlled by antibiotic treatment, is it possible that cyclophosphamide is not required? 2. My finger has been septic for 20 days due to frostbite, how can it heal? Will it aggravate the infection? Wang Qian: Interstitial pneumonia itself is non-infectious, unlike bacterial or viral pneumonia, which is translated as “pneumonia” in Chinese, but there is a difference in English (pneumonitis vs. pneumonia). This means that in the case of simple interstitial pneumonia with scleroderma, antibiotics are not needed, but rather cyclophosphamide. However, interstitial pneumonia may be secondary to infection, and antibiotics should be applied at that time. The atrophy of the fingers and the recurrent infections that do not heal easily are related to the scleroderma vasculopathy that causes ischemia at the fingertips. All the treatment of the symptoms requires wound dressing and prevention and treatment of infections, while the treatment of the root cause requires vasodilation and treatment of scleroderma with immunosuppressants. Scleroderma is definitely not only a skin disease, but a large proportion of patients have internal organ damage (most commonly interstitial lung disease), which is a determining factor in the quality of life and longevity of patients. Our department is currently the only Chinese center among 160 centers participating in the Global Scleroderma Research and Treatment Alliance (EUSTAR organization), and a Scleroderma Patients Association was established earlier this year with more than 120 members, which regularly organizes patient education activities for clinicians with specialized training in scleroderma, and welcomes your consultation and consultation.