Discoid lupus erythematosus. Violaceous, hyperpigmented, atrophic plaques, often with evidence of follicular plugging, which may result in scarring, are characteristic of discoid lupus erythematosus (also called chronic cutaneous lupus erythematosus). Scleroderma and Morphea The skin changes of scleroderma (Chap. 316) usually begin on the hands, feet, and face, with episodes of recurrent nonpitting edema. Sclerosis of the skin begins distally on the fingers (sclerodactyly) and spreads proximally, usually accompanied by resorption of bone of the fingertips, which may have punched out ulcers, stellate scars, or areas of hemorrhage (Fig. 55-7). The fingers may actually shrink in size and become sausage-shaped, and since. | Chapter 055. Immunologically Mediated Skin Diseases Part 9 Figure 55-6 Sowni F-tuciAS. K sp r L . B-r unv ld É. Hiur r S-L. Lornjo Dl_ Jimfion Jl_v Loic l o Ji jç ji jr 17th E Mi nj MSpi H- .f f ifn. 4iciji wj Copyright Tho MdSninMIll Colpin . Inc. All Discoid lupus erythematosus. Violaceous hyperpigmented atrophic plaques often with evidence of follicular plugging which may result in scarring are characteristic of discoid lupus erythematosus also called chronic cutaneous lupus erythematosus . Scleroderma and Morphea The skin changes of scleroderma Chap. 316 usually begin on the hands feet and face with episodes of recurrent nonpitting edema. Sclerosis of the skin begins distally on the fingers sclerodactyly and spreads proximally usually accompanied by resorption of bone of the fingertips which may have punched out ulcers stellate scars or areas of hemorrhage Fig. 55-7 . The fingers may actually shrink in size and become sausage-shaped and since the fingernails are usually unaffected the nails may curve over the end of the fingertips. Periungual telangiectases are usually present but periungual erythema is rare. In advanced cases the extremities show contractures and calcinosis cutis. Facial involvement includes a smooth unwrinkled brow taut skin over the nose shrinkage of tissue around the mouth and perioral radial furrowing Fig. 55-8 . Matlike telangiectases are often present particularly on the face and hands. Involved skin feels indurated smooth and bound to underlying structures hyperpigmentation and hypopigmentation are also often present. Raynaud s phenomenon . cold-induced blanching cyanosis and reactive hyperemia is present in almost all patients and can precede development of scleroderma by many years. The combination of calcinosis cutis Raynaud s phenomenon esophageal dysmotility sclerodactyly and telangiectasia has been termed the CREST syndrome. Anticentromere antibodies have been reported in a very high percentage of patients with the CREST .
