Red spots on face
A 55-year-old man went to his doctor because he was concerned about red spots that had developed on his face 6 months earlier. He also told the doctor that his gastroesophageal reflux disease had recently worsened. When questioned, he acknowledged having problems with circulation in his fingers. He had a history of hypertension, but his blood pressure was only borderline elevated. His fingers were somewhat narrowed at the fingertips with firm skin. No areas of calcium deposits were found in the skin and his lungs were clear to auscultation.
What's your diagnosis?
The patient had several features of the CREST syndrome, which presents with Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias, and calcinosis cutis. His physician suspected that he had systemic sclerosis (scleroderma), a disease characterized by skin induration and thickening accompanied by variable tissue fibrosis and inflammatory infiltration in numerous visceral organs. Systemic sclerosis can be diffuse (DcSSc) or limited to the skin and adjacent tissues (limited cutaneous systemic sclerosis [LcSSc]).
Prominent telangiectasias, like the ones this patient had, can be covered with foundation makeup or treated with laser therapy. Calcium channel blockers, prazosin, prostaglandin derivatives, dipyridamole, aspirin, and topical nitrates may improve symptoms of Raynaud’s phenomenon. Patients should be advised to avoid cold, stress, nicotine, caffeine, and sympathomimetic decongestant medications. Acid reducing agents may be used for GERD.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of Dr. Everett Allen and The Color Atlas of Family Medicine. This case was adapted from: Mayeaux EJ. Scleroderma and morphea. In: Usatine R, Smith M, Mayeaux EJ, et al., eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill;2009:778-783.
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