Scleroderma Like Conditions - Differential Diagnosis Eosinophilic Fasciitis: - Orange peel induration (peau d'orange) of proximal extremities with sparing of hands and facei peripheral eosinophilia, skin retraction over the superficial veins may be more apparent with elevation of an affected limb - Full-thickness skin biopsy demonstrates lymphocytes, plasma cells, and eosinophils infiltrating the deep fascia; glucocorticoids are the mainstay of treatment Nephrogenic Systemic Fibrosis: - Secondary to gadolinium in patients with kidney disease; brawny, wood-like induration of extremities, sparing the digits - Skeletal muscle fibrosis with contractures and/or cardiac muscle involvement can occur, with cardiomyopathy and increased mortality; changes in use and formulation of gadolinium have reduced incidence Scleredema: - Indurated plaques/patches on back, shoulder girdle, and neck - Typically seen in long-standing diabetes mellitus Scleromyxedema: - Waxy, yellow-red papules over thickened skin of face, upper trunk, neck, and arms, deposition of mucin with large numbers of stellate fibroblasts in the dermis - Associated with paraproteinemia (IgGλ) and may therefore occur in the setting of multiple myeloma or AL amyloidosis; more frequent in men Chronic Graft-Versus-Host Disease: - Lichen planus-like skin lesions, or localized or generalized skin thickening - Occurs most commonly after hematopoietic stem cell transplantation; may occasionally be seen after blood transfusion in an immunocompromised host Drug and Toxin Exposure: - Can produce scleroderma-like tissue changes - Examples: bleomycin, docetaxel, pentazocine, L-tryptophan, organic solvents Jacobi Internal Medicine Chiefs @jmcchiefs #Scleroderma #Differential #Diagnosis #comparison #table #dermatology
