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*Chinmaya Murthy

*Senior Resident, Department of Medicine Lady Hardinge Medical College, New Delhi

 

Background:

40year old female patient presented with history of gradually worsening skin tightening over the fingers along with difficulty in opening of mouth.

Findings:

“Salt and Pepper” appearance of skin over Scalp and Upper Back.

Reduced Oral Aperture (Microstomia)

Rhytids’ – Perioral Radial Furrowing.

Description:

Systemic Sclerosis presents with a varied cutaneous manifestation along the course of the disease. Bilateral Symmetrical thickening of the skin starting from the distal extremities to proximal is the Hallmark of this disease.

Salt and Pepper are characterized by the presence of vitiligo like depigmentation with perifollicular pigmentary retention. (1) Perifollicular area sparing occurs because of the preserved melanogenesis due to rich capillary network surrounding the perifollicular area. It also leads to preservation of pigmentation over the veins. (2)

These changes are most prominent over Scalp, Upper Back and Chest.

References:

1.Varga J. Systemic Sclerosis (Scleroderma) and Related Disorders. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 20e. McGraw Hill; 2018.

2.Giberson M, Brassard A. Salt-and-pepper skin changes. New England Journal of Medicine. 2017 Jul 13;377(2):173-.

Disclaimer: – Consent for photography is taken from the patient.