Diagnostic Considerations

Consider the following:

Sclerodermalike disorders
Diffuse scleroderma
Limited scleroderma
Morphea
Mixed connective-tissue disease
Vinyl chloride disease
Silica exposure
Amyloidosis
Eosinophilic fasciitis
Eosinophilia-myalgia syndrome
Toxic oil syndrome
Type 1 diabetes mellitus
Carcinoid syndrome
Myeloma
Paraproteinemia
Scleromyxedema
Chronic graft versus host disease
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes)
Porphyria cutanea tarda
Phenylketonuria
Raynaud phenomenon
Primary Raynaud phenomenon
Secondary Raynaud phenomenon
Livedo reticularis
Acrocyanosis
Diffuse systemic sclerosis
Limited systemic sclerosis
Systemic lupus erythematosus
Dermatomyositis
Rheumatoid arthritis
Sjögren syndrome
Systemic vasculitis
Cryoglobulinemia
Macroglobulinemia
Cold agglutinins
Beta-adrenergic blockers
Nicotine
Ergotamine
Vinyl chloride exposure
Thoracic outlet syndrome
Atherosclerotic disease
Thromboangiitis obliterans (Buerger disease)
Frostbite
Vibratory tool use
Reflex sympathetic dystrophy
Carpal tunnel syndrome
Diabetes mellitus
Calcinosis
Dystrophic calcinosis (normal calcium/phosphorus)
Dermatomyositis
Systemic lupus erythematosus
Scleroderma
Panniculitis
Porphyria cutanea tarda
Ehlers-Danlos syndrome
Pseudoxanthoma elasticum
Werner syndrome
Cutaneous neoplasms
Infections
Trauma
Metastatic calcinosis
Chronic renal failure
Hypervitaminosis D
Milk-alkali syndrome
Neoplasms
Sarcoidosis
Pseudoxanthoma elasticum
Calciphylaxis
Idiopathic calcinosis
Tumoral calcinosis
Subepidermal calcified nodule
Idiopathic calcinosis cutis in Down syndrome
Idiopathic calcification of the scrotum
Iatrogenic calcinosis
Primary telangiectasia
Ataxia telangiectasia
Generalized essential telangiectasia
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
Spider angiomas
Unilateral nevoid telangiectasia syndrome
Secondary telangiectasia
Actinically damaged skin
Postlaser or electrosurgery
Postcryosurgery
Basal cell carcinoma
Collagen-vascular disease
Dermatomyositis
Lupus erythematosus
Scleroderma
Cushing syndrome
Estrogen excess
Cirrhosis
Oral contraceptives
Pregnancy
Poikiloderma
Metastatic carcinoma
Necrobiosis lipoidica diabeticorum
Pseudoxanthoma elasticum
Radiation therapy injury
Rosacea
Generalized cutaneous mastocytosis
Topical steroid induced
Xeroderma pigmentosa

Workup

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Media Gallery

Calcinosis on dorsal forearm.
Close-up view of calcinosis.
Raynaud phenomenon showing pallor of most of the finger tips with a violaceous discoloration (hyperemia) of the thumb tip.
Sclerodactyly (also with Raynaud phenomenon).
Sclerodactyly.
Telangiectasia of the face.
Telangiectasia of the lip.
Telangiectasia of the finger.
Close-up view of telangiectasia.

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Author

Jeanie C Yoon, MD Clinical Instructor, Department of General Internal Medicine, University of Washington School of Medicine

Jeanie C Yoon, MD is a member of the following medical societies: American College of Physicians, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference wish to thank Dr. Bruce Gilliland for assistance in reviewing the manuscript and Dr. Jan V. Hirschmann and Dr. Netayna Sandler for their images.

The authors and editors of Medscape Reference also gratefully acknowledge the contributions of previous authors, Mary A. Wemple, MD, and Kyle L. Horner, MD, MS, to the development and writing of this article.