PMC9944634_01
(A) Diffuse sclerosis (dark pigmentation) on the neck. (B) Diffuse sclerosis on the back (tiny spots of dark pigmentation).
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FIG1
On physical examination of the skin lesions, inspection showed there was bilateral forearm induration extending from the neck to the back and anterior trunk with dark discoloration (Figures 1A, 1B).
Hands of the patient are spared from the lesions.
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FIG2
There were no signs of microstomia, telangiectasia, Raynaud's phenomenon, acral pigmentation, digital ulcers, peau d'orange appearance or pitted scars while the hands and feet were spared with normal nail capilloscopy (Figure 2).
Histopathology slide of a 4-mm punch biopsy from the right forearm showing mildly spaced collagen bundles (magnification x40).
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FIG3
A 4-mm punch biopsy from the right forearm was performed and revealed a mildly spaced collagen bundles without any sign of mucin deposition (Figure 3).
Second biopsy shows mild mucin deposition between the collagen (magnification x40).
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FIG4
The biopsy showed deposition of mucin and increased mast cells suggestive of scleredema (Figure 4).