To cite: Sahai M, Oliver AM. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013008584 DESCRIPTION A 46-year-old man with a history of hypertension presented with a 6-month history of progressive, diffuse skin thickening. He denied any exposure to new drugs, toxins or contrast material, had no history of Raynaud’s disease or endocrine disorder. Physical examinati...

A 39-year-old African American woman was referred in April 1995 with a 1-year history of skin thickening. The process began on her hands and progressed to involve her arms, face, neck, shoulders, chest, and proximal extremities. Her only systemic complaints were limited mobility of her joints, particularly her hands and wrists. Physical examination findings revealed leonine facies. The skin of ...