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Systemic dermatology

Connective tissue diseases diagnostic challenge

Match each picture with the correct diagnosis: Mix and match: [table] : Scleroderma || Scleroactyly in this patient is due to advanced systemic sclerosis. Note her inability to straighten her tapered pale fingers. : Rheumatoid arthritis || Rheumatic nodules are associated with active disease, positive rheumatoid factor and smoking. : Lupus erythematosus || Discoid lupus (illustrated) causes erythematous scaly plaques on the nose and cheeks, whereas systemic lupus results in erythematous macules in the same distribution. : Dermatomyositis || The rash of dermatomyositis may be subtle and affect face, chest, arms and hands. Typically it is a macular or slightly scaly eruption with a violaceous hue. Mix and match: [table] : Discoid LE || Discoid lupus causes sharply marginated scaly plaques, which show spines on the under-surface (carpet-tacks). Severe disease results in scarring. : Systemic LE || Periungual erythematous macules and papules are common in acute systemic lupus. They spare the knuckles, in contrast to dermatomyositis. Cuticular telangiectasia may be observed using a dermatoscope.
© R Suhonen: Subacute LE || Bright red annular lesions with central regression and little scaling are characteristic of subacute lupus, often precipitated by sun exposure. : Discoid LE || When discoid lupus affects the scalp, it frequently results in permanent scarring alopecia. In contrast, systemic lupus more often causes a diffuse reversible alopecia.