RT Book, Section A1 Mayeaux, Jr., E.J. A1 Usatine, Richard P. A2 Usatine, Richard P. A2 Smith, Mindy A. A2 Mayeaux, Jr., E.J. A2 Chumley, Heidi S. SR Print(0) ID 1164362298 T1 Scleroderma and Morphea T2 The Color Atlas and Synopsis of Family Medicine, 3e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259862045 LK dermatology.mhmedical.com/content.aspx?aid=1164362298 RD 2024/03/28 AB A 49-year-old woman presents with skin changes on her face and hands and gastroesophageal reflux disease. Examination of her face shows multiple telangiectasias and tight skin over her nose and around her mouth (Figure 190-1). Examination of her hands shows tight skin over the fingers with some deformities due to the tightening of the skin (Figure 190-2). A closer look at an individual finger shows pitting of the skin and loss of the soft tissue of the distal phalanx (Figure 190-3). A "salt-and-pepper" appearance is noted on the forearms (Figure 190-4) and lower legs. Some firm nodules around the elbows are consistent with calcinosis. Her cardiopulmonary exam is normal. Further history reveals Raynaud's phenomenon. A diagnosis of CREST syndrome and scleroderma is made. The physician orders blood tests, chest X-ray (CXR), and pulmonary function tests (PFTs) to determine if this is limited cutaneous systemic sclerosis or diffuse systemic sclerosis.