Case history
Case history #1
A 45-year-old woman with a history of Raynaud phenomenon (RP) for 5 years presents with puffy fingers, a fingertip ulcer, new GERD, and telangiectasia on exam that are round, blanchable, and large. She has no calcinosis.
Case history #2
A 51-year-old woman presents with 4 kg weight loss, RP, and difficulty swallowing. Exam shows puffy, tight fingers and swollen joints. Movement of wrists and ankles demonstrates tendon friction rubs. Dilated capillaries are visible in the nailbeds and cuticles.
Other presentations
Limited cutaneous systemic sclerosis (lcSSc) begins in the fingers with sclerodactyly and often involves the face and neck. It may advance more proximally from the dorsum of the hands or feet; however, if it does, it generally goes no more proximal than the elbows or knees, respectively. It does not involve the trunk. In contrast, diffuse cutaneous systemic sclerosis (dcSSc) typically starts at the fingers with sclerodactyly and moves proximally on to the arms; however, the first presentation can be renal crisis, before the skin is involved, where malignant hypertension is followed by progressive skin changes.[2] RP is generally present in either the months before or after other symptoms manifest in dcSSc; however, in lcSSc, it is often present for years (mean 8 years) before other symptoms manifest. Some patients with Sjogren syndrome have features of lcSSc.
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