|
| Fig. 22.8 Progressive systemic sclerosis. Characteristic sclerodactyly manifesting as tight, shiny, thickened skin. (Courtesy of James E. Fitzpatrick, MD.) |
The earliest cutaneous complaints of PSS are often swelling of the hands and feet or symptoms associated with Raynaud’s phenomenon. Telangiectasia may also develop early in the course of disease. The proximal nail folds show changes in the capillaries, including avascular areas (dropout) and marked dilatation. Over time, the skin of the digits becomes thickened and sclerotic (Fig. 22-8). Sclerotic changes are often progressive, involving the face and extremities, and may eventually involve large areas of the body. Other late changes include digital ulcers and even loss of the digits.
