How do you approach symptom control in a patient with diffuse cutaneous systemic sclerosis (dcSSc) and rapidly progressive skin disease?

This patient clearly seems to be on the uphill trajectory for skin involvement in RNA Pol III+ dcSSc which can progress quite rapidly over 6-12 months. Pain, burning, tightness and pruritus are quite intense during this period, and can be very difficult to treat. It does improve somewhat with time, ...