Systemic sclerosis (scleroderma) Quiz: Ace Your Exams

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A 36-year-old woman presents to the clinic for evaluation of frequent episodes of color changes and pain in her fingers when she is exposed to cold temperatures. She also has had progressive tightening and thickening of the skin on her hands and forearms for the past 6 months. She mentions frequent heartburn and difficulty swallowing. Vitals are within normal limits. On physical examination, the skin appears shiny and tight with decreased mobility over the fingers bilaterally and extending proximally to the elbows. There are no other areas of skin thickening or tightening. Full strength is present in the upper and lower extremities. Laboratory studies are pending. Which of the following additional physical exam findings would most likely be present given this patient’s likely underlying condition?

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Firm white nodules on the fingers

Purple discoloration of the eyelids

Excessive hair growth on the face and body

Erythema of the cheeks sparing the nasolabial folds

Erythematous, papulosquamous eruption over the dorsal surfaces of the knuckles