in the elderly . Progressive systemic sclerosis

Introduction Although there is no universally agreed classification of scleroderma, the following is most generally accepted (Rowell, 1977): (i) morphoea (localized or generalized); (ii) progressive systemic sclerosis; (iii) pseudo scleroderma; (iv) occupational scleroderma. Progressive systemic sclerosis usually begins in middle age, but there is a wide range in the age of onset. Rodnan (1963) found that the incidence by age at diagnosis increases steadily, reaching a peak in the over 65 years age group. The findings of Medsger and Masi (1971) support this view. Clinically detectable changes in internal organs usually appear several years after the skin manifestations; however, visceral involvement may occur first and the diagnosis may be overlooked until skin changes appear. In some cases there has been severe systemic involvement with only minor cutaneous changes (Rodnan and Fennell, 1962). The following case histories illustrate the need to consider this condition in elderly patients despite the absence of typical skin changes, especially if there is a history of Raynaud's phenomenon.