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Scleroderma

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</style><div role="note" class="hatnote navigation-not-searchable">This article is about the disease. For the mushroom, see <a href="Scleroderma_(fungus)" title="Scleroderma (fungus)">Scleroderma (fungus)</a>.</div>

<div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="Scleredema" title="Scleredema">scleredema</a>.</div>

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</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Scleroderma</th></tr><tr><td colspan="2" class="infobox-full-data"></td></tr><tr><td colspan="2" class="infobox-full-data">A type of localized scleroderma known as <a href="Morphea" title="Morphea">morphea</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="Rheumatology" title="Rheumatology">Rheumatology</a></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Middle age<a href="#cite_note-NORD2007-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data">Localized, <a href="Systemic_scleroderma" title="Systemic scleroderma">systemic scleroderma</a><a href="#cite_note-GARD2017-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Cause_(medicine)" title="Cause (medicine)">Causes</a></th><td class="infobox-data">Unknown<a href="#cite_note-GARD2017-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Family history, certain <a href="Genetics" title="Genetics">genetic</a> factors, exposure to <a href="Silica" class="mw-redirect" title="Silica">silica</a><a href="#cite_note-Har2018-3">[3]</a><a href="#cite_note-Bar2012-4">[4]</a><a href="#cite_note-Gre2013-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms, <a href="Skin_biopsy" title="Skin biopsy">skin biopsy</a>, blood tests<a href="#cite_note-NIH2016-6">[6]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="Mixed_connective_tissue_disease" title="Mixed connective tissue disease">Mixed connective tissue disease</a>, <a href="Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">systemic lupus erythematosus</a>, <a href="Polymyositis" title="Polymyositis">polymyositis</a>, <a href="Dermatomyositis" title="Dermatomyositis">dermatomyositis</a><a href="#cite_note-NORD2007-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="Supportive_care" class="mw-redirect" title="Supportive care">Supportive care</a><a href="#cite_note-NORD2007-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="Corticosteroids" class="mw-redirect" title="Corticosteroids">Corticosteroids</a>, <a href="Methotrexate" title="Methotrexate">methotrexate</a>, <a href="Non-steroidal_anti-inflammatory_drugs" class="mw-redirect" title="Non-steroidal anti-inflammatory drugs">non-steroidal anti-inflammatory drugs</a> (NSAIDs)<a href="#cite_note-GARD2017-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Localized: Normal life expectancy<a href="#cite_note-Un2006-7">[7]</a> Systemic: Decreased life expectancy<a href="#cite_note-Har2018-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">3 per 100,000 per year (systemic)<a href="#cite_note-Har2018-3">[3]</a></td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">

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Scleroderma is a group of <a href="Autoimmune_disease" title="Autoimmune disease">autoimmune diseases</a> that may result in changes to the <a href="Human_skin" title="Human skin">skin</a>, <a href="Blood_vessels" class="mw-redirect" title="Blood vessels">blood vessels</a>, <a href="Muscles" class="mw-redirect" title="Muscles">muscles</a>, and <a href="Internal_organ" class="mw-redirect" title="Internal organ">internal organs</a>.<a href="#cite_note-GARD2017-2">[2]</a><a href="#cite_note-NIH2016-6">[6]</a><a href="#cite_note-8">[8]</a> The disease can be either localized to the skin or involve other organs, as well.<a href="#cite_note-GARD2017-2">[2]</a> Symptoms may include areas of thickened skin, stiffness, feeling tired, and poor blood flow to the fingers or toes with cold exposure.<a href="#cite_note-NORD2007-1">[1]</a> One form of the condition, known as <a href="CREST_syndrome" title="CREST syndrome">CREST syndrome</a>, classically results in <a href="Calcinosis" title="Calcinosis">calcium deposits</a>, <a href="Raynaud's_syndrome" class="mw-redirect" title="Raynaud's syndrome">Raynaud's syndrome</a>, <a href="Esophagus" title="Esophagus">esophageal</a> problems, <a href="Sclerodactyly" title="Sclerodactyly">thickening of the skin of the fingers and toes</a>, and <a href="Telangiectasia" title="Telangiectasia">areas of small, dilated blood vessels</a>.<a href="#cite_note-NORD2007-1">[1]</a>

The cause is unknown, but it may be due to an abnormal immune response.<a href="#cite_note-GARD2017-2">[2]</a> Risk factors include family history, certain <a href="Genetics" title="Genetics">genetic</a> factors, and exposure to <a href="Silica" class="mw-redirect" title="Silica">silica</a>.<a href="#cite_note-Har2018-3">[3]</a><a href="#cite_note-Bar2012-4">[4]</a><a href="#cite_note-Gre2013-5">[5]</a> The underlying mechanism involves the abnormal growth of <a href="Connective_tissue" title="Connective tissue">connective tissue</a>, which is believed to be the result of the immune system attacking healthy tissues.<a href="#cite_note-NIH2016-6">[6]</a> Diagnosis is based on symptoms, supported by a <a href="Skin_biopsy" title="Skin biopsy">skin biopsy</a> or blood tests.<a href="#cite_note-NIH2016-6">[6]</a>

While no cure is known, treatment may improve symptoms.<a href="#cite_note-GARD2017-2">[2]</a> Medications used include <a href="Corticosteroids" class="mw-redirect" title="Corticosteroids">corticosteroids</a>, <a href="Methotrexate" title="Methotrexate">methotrexate</a>, and <a href="Non-steroidal_anti-inflammatory_drugs" class="mw-redirect" title="Non-steroidal anti-inflammatory drugs">non-steroidal anti-inflammatory drugs</a> (NSAIDs).<a href="#cite_note-GARD2017-2">[2]</a> Outcome depends on the extent of disease.<a href="#cite_note-Har2018-3">[3]</a> Those with localized disease generally have a normal <a href="Life_expectancy" title="Life expectancy">life expectancy</a>.<a href="#cite_note-Un2006-7">[7]</a> In those with systemic disease, life expectancy can be affected, and this varies based on subtype.<a href="#cite_note-Har2018-3">[3]</a> Death is often due to lung, gastrointestinal, or heart complications.<a href="#cite_note-Har2018-3">[3]</a>

About three per 100,000 people per year develop the systemic form.<a href="#cite_note-Har2018-3">[3]</a> The condition most often begins in middle age.<a href="#cite_note-NORD2007-1">[1]</a> Women are more often affected than men.<a href="#cite_note-NORD2007-1">[1]</a> Scleroderma symptoms were first described in 1753 by Carlo Curzio<a href="#cite_note-9">[9]</a> and then well documented in 1842.<a href="#cite_note-10">[10]</a> The term is from the <a href="Ancient_Greek" title="Ancient Greek">Greek</a> skleros meaning "hard" and derma meaning "skin".<a href="#cite_note-11">[11]</a><a href="#cite_note-12">[12]</a>

<div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2></div>

Potential signs and symptoms include:<a href="#cite_note-MM-13">[13]</a><a href="#cite_note-PMSR-14">[14]</a><a href="#cite_note-Harrison-15">[15]</a><a href="#cite_note-16">[16]</a>

<ul><li>Cardiovascular: <a href="Raynaud's_phenomenon" class="mw-redirect" title="Raynaud's phenomenon">Raynaud's phenomenon</a> (is the presenting symptom in 30% of affected persons, occurs in 95% of affected individuals at some time during their illness); healed pitting <a href="Ulcers" class="mw-redirect" title="Ulcers">ulcers</a> on the fingertips; skin and mucosal <a href="Telangiectasis" class="mw-redirect" title="Telangiectasis">telangiectasis</a>; <a href="Palpitations" title="Palpitations">palpitations</a>, irregular heart rate and <a href="Syncope_(medicine)" title="Syncope (medicine)">fainting</a> due to <a href="Electrical_conduction_system_of_the_heart" class="mw-redirect" title="Electrical conduction system of the heart">conduction</a> abnormalities, <a href="Hypertension" title="Hypertension">hypertension</a>, and <a href="Congestive_heart_failure" class="mw-redirect" title="Congestive heart failure">congestive heart failure</a></li>

<li>Digestive: <a href="Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux disease</a>, bloating, <a href="Dyspepsia" class="mw-redirect" title="Dyspepsia">indigestion</a>, loss of appetite, <a href="Diarrhoea" class="mw-redirect" title="Diarrhoea">diarrhoea</a> alternating with <a href="Constipation" title="Constipation">constipation</a>, <a href="Sicca_syndrome" class="mw-redirect" title="Sicca syndrome">sicca syndrome</a> and its complications, <a href="Gastric_antral_vascular_ectasia" title="Gastric antral vascular ectasia">gastric antral vascular ectasia</a>, loosening of teeth, and hoarseness (due to acid reflux).</li>

<li>Pulmonary: progressive worsening of shortness of breath, chest pain (due to <a href="Pulmonary_artery_hypertension" class="mw-redirect" title="Pulmonary artery hypertension">pulmonary artery hypertension</a>), and dry, persistent cough due to <a href="Interstitial_lung_disease" title="Interstitial lung disease">interstitial lung disease</a></li>

<li>Musculoskeletal: <a href="Arthralgia" title="Arthralgia">joint</a>, <a href="Myalgia" title="Myalgia">muscle aches</a>, loss of joint range of motion, <a href="Carpal_tunnel_syndrome" title="Carpal tunnel syndrome">carpal tunnel syndrome</a>, and <a href="Asthenia" class="mw-redirect" title="Asthenia">muscle weakness</a></li>

<li>Genitourinary: <a href="Erectile_dysfunction" title="Erectile dysfunction">erectile dysfunction</a>, <a href="Dyspareunia" title="Dyspareunia">dyspareunia</a>, kidney problems, or <a href="Kidney_failure" title="Kidney failure">kidney failure</a></li>

<li>Other: facial pain due to <a href="Trigeminal_neuralgia" title="Trigeminal neuralgia">trigeminal neuralgia</a>, hand <a href="Paresthesias" class="mw-redirect" title="Paresthesias">paresthesias</a>, headache, <a href="Stroke" title="Stroke">stroke</a>, fatigue, <a href="Calcinosis" title="Calcinosis">calcinosis</a>, and weight loss</li></ul>

<div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2></div>

Scleroderma is caused by genetic and environmental factors.<a href="#cite_note-Bar2012-4">[4]</a><a href="#cite_note-Gre2013-5">[5]</a><a href="#cite_note-path12-17">[17]</a><a href="#cite_note-env13-18">[18]</a> Mutations in <a href="Human_leukocyte_antigen" title="Human leukocyte antigen">HLA</a> genes seem to play a crucial role in the <a href="Pathogenesis" title="Pathogenesis">pathogenesis</a> of some cases; likewise <a href="Silica" class="mw-redirect" title="Silica">silica</a>, <a href="Aromatic_hydrocarbon" class="mw-redirect" title="Aromatic hydrocarbon">aromatic</a> and <a href="Chlorinated_hydrocarbon" class="mw-redirect" title="Chlorinated hydrocarbon">chlorinated</a> solvents, <a href="Ketones" class="mw-redirect" title="Ketones">ketones</a>, <a href="Trichloroethylene" title="Trichloroethylene">trichloroethylene</a>, <a href="Welding" title="Welding">welding</a> fumes, and <a href="Mineral_spirits" class="mw-redirect" title="Mineral spirits">white spirits</a> exposure seems to contribute to the condition in a small proportion of affected persons.<a href="#cite_note-Bar2012-4">[4]</a><a href="#cite_note-Gre2013-5">[5]</a><a href="#cite_note-path12-17">[17]</a><a href="#cite_note-env13-18">[18]</a><a href="#cite_note-19">[19]</a>

<div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2></div>

Scleroderma is characterised by increased <a href="Biosynthesis" title="Biosynthesis">synthesis</a> of <a href="Collagen" title="Collagen">collagen</a> (leading to the <a href="Sclerosis_(medicine)" title="Sclerosis (medicine)">sclerosis</a>), damage to small blood vessels, activation of <a href="T_lymphocytes" class="mw-redirect" title="T lymphocytes">T lymphocytes</a>, and production of altered <a href="Connective_tissue" title="Connective tissue">connective tissue</a>.<a href="#cite_note-20">[20]</a> Its proposed pathogenesis is the following:<a href="#cite_note-path11-21">[21]</a><a href="#cite_note-22">[22]</a><a href="#cite_note-23">[23]</a><a href="#cite_note-24">[24]</a><a href="#cite_note-25">[25]</a>

<ul><li>It begins with an inciting event at the level of the <a href="Vasculature" class="mw-redirect" title="Vasculature">vasculature</a>, probably the <a href="Endothelium" title="Endothelium">endothelium</a>. The inciting event is yet to be elucidated, but may be a viral agent, <a href="Oxidative_stress" title="Oxidative stress">oxidative stress</a>, or autoimmune. <a href="Endothelial_cell" class="mw-redirect" title="Endothelial cell">Endothelial cell</a> damage and <a href="Apoptosis" title="Apoptosis">apoptosis</a> ensue, leading to the vascular leakiness that manifests in early clinical stages as tissue <a href="Oedema" class="mw-redirect" title="Oedema">oedema</a>. At this stage, it is predominantly a <a href="Th1_cell" class="mw-redirect" title="Th1 cell">Th1</a>- and <a href="Th17" class="mw-redirect" title="Th17">Th17</a>-mediated disease.</li>

<li>After this, the vasculature is further compromised by impaired <a href="Angiogenesis" title="Angiogenesis">angiogenesis</a> and impaired <a href="Vasculogenesis" title="Vasculogenesis">vasculogenesis</a> (fewer endothelial progenitor cells), likely related to the presence of antiendothelial cell antibodies (AECA). Despite this impaired <a href="Angiogenesis" title="Angiogenesis">angiogenesis</a>, elevated levels of pro-angiogenic growth factors such as <a href="Platelet_derived_growth_factor" class="mw-redirect" title="Platelet derived growth factor">PDGF</a> and <a href="Vascular_endothelial_growth_factor" title="Vascular endothelial growth factor">VEGF</a> are often seen in persons with the condition. The balance of <a href="Vasodilation" title="Vasodilation">vasodilation</a> and vasoconstriction becomes askew, and the net result is vasoconstriction. The damaged endothelium then serves as a point of origin for blood-clot formation and further contributes to <a href="Ischaemia" class="mw-redirect" title="Ischaemia">ischaemia</a>-<a href="Reperfusion_injury" title="Reperfusion injury">reperfusion injury</a> and the generation of <a href="Reactive_oxygen_species" title="Reactive oxygen species">reactive oxygen species</a>. These later stages are characterised by <a href="Th2" class="mw-redirect" title="Th2">Th2</a> polarity.</li>

<li>The damaged endothelium upregulates <a href="Adhesion_molecules" class="mw-redirect" title="Adhesion molecules">adhesion molecules</a> and <a href="Chemokine" title="Chemokine">chemokines</a> to attract <a href="Leucocyte" class="mw-redirect" title="Leucocyte">leucocytes</a>, which enables the development of innate and adaptive immune responses, including loss of tolerance to various oxidised <a href="Antigens" class="mw-redirect" title="Antigens">antigens</a>, which includes <a href="Topoisomerase_I" class="mw-redirect" title="Topoisomerase I">topoisomerase I</a>. <a href="B_cells" class="mw-redirect" title="B cells">B cells</a> mature into <a href="Plasma_cells" class="mw-redirect" title="Plasma cells">plasma cells</a>, which furthers the autoimmune component of the condition. T cells differentiate into subsets, including Th2 cells, which play a vital role in tissue <a href="Fibrosis" title="Fibrosis">fibrosis</a>. <a href="Topoisomerase_1" class="mw-redirect" title="Topoisomerase 1">Anti–topoisomerase 1</a> <a href="Antibodies" class="mw-redirect" title="Antibodies">antibodies</a>, in turn, stimulate <a href="Type_I_interferon" class="mw-redirect" title="Type I interferon">type I interferon</a> production.</li>

<li><a href="Fibroblast" title="Fibroblast">Fibroblasts</a> are recruited and activated by multiple <a href="Cytokine" title="Cytokine">cytokines</a> and growth factors to generate <a href="Myofibroblasts" class="mw-redirect" title="Myofibroblasts">myofibroblasts</a>. Dysregulated <a href="Transforming_growth_factor_%CE%B2" class="mw-redirect" title="Transforming growth factor β">transforming growth factor β</a> (TGF-β) signalling in fibroblasts and myofibroblasts has been observed in multiple studies of scleroderma-affected individuals. Activation of fibroblasts and myofibroblasts leads to excessive deposition of collagen and other related proteins, leading to fibrosis. B cells are implicated in this stage, <a href="Interleukin_6" title="Interleukin 6">IL-6</a> and TGF-β produced by the B cells decrease collagen degradation and increase <a href="Extracellular_matrix" title="Extracellular matrix">extracellular matrix</a> production. <a href="Endothelin" title="Endothelin">Endothelin signalling</a> is implicated in the pathophysiology of fibrosis.<a href="#cite_note-26">[26]</a></li></ul>

<a href="Vitamin_D" title="Vitamin D">Vitamin D</a> is implicated in the pathophysiology of the disease. An inverse correlation between plasma levels of vitamin D and scleroderma severity has been noted, and vitamin D is known to play a crucial role in regulating (usually suppressing) the actions of the immune system.<a href="#cite_note-27">[27]</a>

<div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div>

Typical scleroderma is classically defined as symmetrical skin thickening, with about 70% of cases also presenting with Raynaud's phenomenon, nail-fold capillary changes, and <a href="Anti-nuclear_antibody" class="mw-redirect" title="Anti-nuclear antibody">antinuclear antibodies</a>. Affected individuals may experience systemic organ involvement. No single test for scleroderma works all of the time; hence, diagnosis is often a matter of exclusion. Atypical scleroderma may show any variation of these changes without skin changes or with finger swelling only.<a href="#cite_note-WMSR-28">[28]</a>

Laboratory testing can show <a href="Anti-topoisomerase_antibodies" title="Anti-topoisomerase antibodies">antitopoisomerase antibodies</a>, like <a href="Anti-scl70" class="mw-redirect" title="Anti-scl70">anti-scl70</a> (causing a diffuse systemic form), or <a href="Anti-centromere_antibodies" class="mw-redirect" title="Anti-centromere antibodies">anticentromere antibodies</a> (causing a limited systemic form and the CREST syndrome). Other autoantibodies can be seen, such as anti-U3 or anti-RNA polymerase.<a href="#cite_note-MSR-29">[29]</a>

Antidouble-stranded DNA autoantibodies are likely to be present in serum.

<div class="mw-heading mw-heading3"><h3 id="Differential">Differential</h3></div>

Diseases that are often in the differential include:<a href="#cite_note-DMSR-30">[30]</a>

<ul><li><a href="Eosinophilia" title="Eosinophilia">Eosinophilia</a> is a condition in which too many <a href="Eosinophils" class="mw-redirect" title="Eosinophils">eosinophils</a> (a type of immune cell that attacks parasites and is involved in certain allergic reactions) are present in the blood.</li>

<li><a href="Eosinophilia-myalgia_syndrome" class="mw-redirect" title="Eosinophilia-myalgia syndrome">Eosinophilia-myalgia syndrome</a> is a form of eosinophilia caused by <a href="L-tryptophan" class="mw-redirect" title="L-tryptophan">L-tryptophan</a> supplements.</li>

<li><a href="Eosinophilic_fasciitis" title="Eosinophilic fasciitis">Eosinophilic fasciitis</a> affects the connective tissue surrounding skeletal muscles, bones, blood vessels, and nerves in the arms and legs.</li>

<li><a href="Graft-versus-host_disease" title="Graft-versus-host disease">Graft-versus-host disease</a> is an autoimmune condition that occurs as a result of bone-marrow transplants in which the immune cells from the transplanted bone marrow attack the host's body.</li>

<li><a href="Mycosis_fungoides" title="Mycosis fungoides">Mycosis fungoides</a> is a type of <a href="Cutaneous_T_cell_lymphoma" class="mw-redirect" title="Cutaneous T cell lymphoma">cutaneous T cell lymphoma</a>, a rare cancer that causes rashes all over the body.</li>

<li><a href="Nephrogenic_systemic_fibrosis" title="Nephrogenic systemic fibrosis">Nephrogenic systemic fibrosis</a> is a condition usually caused by <a href="Kidney_failure" title="Kidney failure">kidney failure</a> that results in fibrosis (thickening) of the tissues.</li>

<li><a href="Primary_biliary_cirrhosis" class="mw-redirect" title="Primary biliary cirrhosis">Primary biliary cirrhosis</a> is an autoimmune disease of the liver.</li>

<li><a href="Primary_pulmonary_hypertension" class="mw-redirect" title="Primary pulmonary hypertension">Primary pulmonary hypertension</a></li>

<li><a href="Complex_regional_pain_syndrome" title="Complex regional pain syndrome">Complex regional pain syndrome</a></li></ul>

<div class="mw-heading mw-heading3"><h3 id="Classification">Classification</h3></div>

Scleroderma is characterised by the appearance of circumscribed or diffuse, hard, smooth, ivory-colored areas that are immobile and which give the appearance of hidebound skin, a disease occurring in both localised and systemic forms:<a href="#cite_note-31">[31]</a>

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<ul><li><a href="Localised_scleroderma" class="mw-redirect" title="Localised scleroderma">Localised scleroderma</a>

<ul><li><a href="Localised_morphea" class="mw-redirect" title="Localised morphea">Localised morphea</a></li>

<li><a href="Morphea-lichen_sclerosus_et_atrophicus_overlap" class="mw-redirect" title="Morphea-lichen sclerosus et atrophicus overlap">Morphea-lichen sclerosus et atrophicus overlap</a></li>

<li><a href="Generalised_morphea" class="mw-redirect" title="Generalised morphea">Generalised morphea</a></li>

<li><a href="Atrophoderma_of_Pasini_and_Pierini" class="mw-redirect" title="Atrophoderma of Pasini and Pierini">Atrophoderma of Pasini and Pierini</a></li>

<li><a href="Pansclerotic_morphea" class="mw-redirect" title="Pansclerotic morphea">Pansclerotic morphea</a></li>

<li><a href="Morphea_profunda" class="mw-redirect" title="Morphea profunda">Morphea profunda</a></li>

<li><a href="Linear_scleroderma" class="mw-redirect" title="Linear scleroderma">Linear scleroderma</a></li></ul></li>

<li><a href="Systemic_scleroderma" title="Systemic scleroderma">Systemic scleroderma</a>

<ul><li><a href="CREST_syndrome" title="CREST syndrome">CREST syndrome</a></li>

<li><a href="Progressive_systemic_sclerosis" class="mw-redirect" title="Progressive systemic sclerosis">Progressive systemic sclerosis</a></li></ul></li></ul>

</div>

<div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2></div>

No cure for scleroderma is known, although relief of symptoms is often achieved; these include treatment of:<a href="#cite_note-MM-13">[13]</a><a href="#cite_note-sem-32">[32]</a>

<ul><li><a href="Raynaud's_phenomenon" class="mw-redirect" title="Raynaud's phenomenon">Raynaud's phenomenon</a> with vasodilators such as <a href="Calcium_channel_blockers" class="mw-redirect" title="Calcium channel blockers">calcium channel blockers</a>, <a href="Alpha_blocker" title="Alpha blocker">alpha blockers</a>, <a href="Serotonin_receptor_antagonist" title="Serotonin receptor antagonist">serotonin receptor antagonists</a>, <a href="Angiotensin_II_receptor" title="Angiotensin II receptor">angiotensin II receptor</a> inhibitors, <a href="Statins" class="mw-redirect" title="Statins">statins</a>, local nitrates or <a href="Iloprost" title="Iloprost">iloprost</a></li>

<li>Digital ulcers with <a href="Phosphodiesterase_5" class="mw-redirect" title="Phosphodiesterase 5">phosphodiesterase 5</a> inhibitors (e.g., <a href="Sildenafil" title="Sildenafil">sildenafil</a>) or <a href="Iloprost" title="Iloprost">iloprost</a></li>

<li>Prevention of new digital ulcers with <a href="Bosentan" title="Bosentan">bosentan</a></li>

<li>Malnutrition, secondary to intestinal flora overgrowth with <a href="Tetracycline_antibiotic" class="mw-redirect" title="Tetracycline antibiotic">tetracycline antibiotics</a> such as <a href="Tetracycline" title="Tetracycline">tetracycline</a></li>

<li><a href="Interstitial_lung_disease" title="Interstitial lung disease">Interstitial lung disease</a> with <a href="Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>, <a href="Azathioprine" title="Azathioprine">azathioprine</a> with or without corticosteroids</li>

<li><a href="Pulmonary_arterial_hypertension" title="Pulmonary arterial hypertension">Pulmonary arterial hypertension</a> with endothelin receptor antagonists, phosphodiesterase 5 inhibitors, and prostanoids</li>

<li>Gastrooesophageal reflux disease with antacids or prokinetics</li>

<li>Kidney crises with <a href="Angiotensin_converting_enzyme_inhibitor" class="mw-redirect" title="Angiotensin converting enzyme inhibitor">angiotensin converting enzyme inhibitors</a> and <a href="Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">angiotensin II receptor antagonists</a></li></ul>

Systemic <a href="Disease-modifying_treatment" title="Disease-modifying treatment">disease-modifying treatment</a> with immunosuppressants is often used.<a href="#cite_note-path12-17">[17]</a><a href="#cite_note-clin13-33">[33]</a><a href="#cite_note-mayo-34">[34]</a><a href="#cite_note-pol-35">[35]</a><a href="#cite_note-arch-36">[36]</a><a href="#cite_note-exp-37">[37]</a> Immunosuppressants used in its treatment include <a href="Azathioprine" title="Azathioprine">azathioprine</a>, <a href="Methotrexate" title="Methotrexate">methotrexate</a>, <a href="Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>, <a href="Mycophenolate" class="mw-redirect" title="Mycophenolate">mycophenolate</a>, intravenous <a href="Immunoglobulin" class="mw-redirect" title="Immunoglobulin">immunoglobulin</a>, <a href="Rituximab" title="Rituximab">rituximab</a>, <a href="Sirolimus" title="Sirolimus">sirolimus</a>, <a href="Alefacept" title="Alefacept">alefacept</a>, and the tyrosine kinase inhibitors, <a href="Imatinib" title="Imatinib">imatinib</a>, <a href="Nilotinib" title="Nilotinib">nilotinib</a>, and <a href="Dasatinib" title="Dasatinib">dasatinib</a>.<a href="#cite_note-path12-17">[17]</a><a href="#cite_note-sem-32">[32]</a><a href="#cite_note-clin13-33">[33]</a><a href="#cite_note-mayo-34">[34]</a><a href="#cite_note-pol-35">[35]</a><a href="#cite_note-arch-36">[36]</a><a href="#cite_note-exp-37">[37]</a><a href="#cite_note-38">[38]</a>

Experimental therapies under investigation include endothelin receptor antagonists, tyrosine kinase inhibitors, beta-glycan peptides, <a href="Halofuginone" title="Halofuginone">halofuginone</a>, <a href="Basiliximab" title="Basiliximab">basiliximab</a>, <a href="Alemtuzumab" title="Alemtuzumab">alemtuzumab</a>, <a href="Abatacept" title="Abatacept">abatacept</a>, and <a href="Haematopoietic_stem_cell_transplantation" class="mw-redirect" title="Haematopoietic stem cell transplantation">haematopoietic stem cell transplantation</a>.<a href="#cite_note-39">[39]</a><a href="#cite_note-40">[40]</a>

<th colspan="5">Immunomodulatory agents in the treatment of scleroderma

</th></tr>

<tr>

<th>Mechanism of action<a href="#cite_note-AMH-41">[41]</a><a href="#cite_note-GG-42">[42]</a></th>

<th>Route of administration<a href="#cite_note-AMH-41">[41]</a></th>

<th>Pregnancy category<a href="#cite_note-AMH-41">[41]</a><a href="#cite_note-MSRD-43">[43]</a></th>

<th>Major toxicities<a href="#cite_note-AMH-41">[41]</a>

</th></tr>

<tr>

<td><a href="Alefacept" title="Alefacept">Alefacept</a></td>

<td>Monoclonal antibody to inhibit T lymphocyte activation by binding to CD2 portion of <a href="Human_leukocyte_antigen" title="Human leukocyte antigen">human leukocyte function antigen-3</a>.</td>

<td>Malignancies, injection site reactions, blood clots, <a href="Lymphopenia" class="mw-redirect" title="Lymphopenia">lymphopenia</a>, hepatotoxicity and infections.

</td></tr>

<tr>

<td><a href="Azathioprine" title="Azathioprine">Azathioprine</a></td>

<td>Purine analogue that inhibits lymphocyte proliferation via conversion to <a href="Mercaptopurine" title="Mercaptopurine">mercaptopurine</a></td>

<td><a href="Myelosuppression" class="mw-redirect" title="Myelosuppression">Myelosuppression</a> and rarely malignancy, hepatitis, infection, <a href="Hepatic_sinusoidal_obstruction_syndrome" class="mw-redirect" title="Hepatic sinusoidal obstruction syndrome">hepatic sinusoidal obstruction syndrome</a> and hypersensitivity reactions.

</td></tr>

<tr>

<td><a href="Cyclophosphamide" title="Cyclophosphamide">Cyclophosphamide</a></td>

<td>Nitrogen mustard that cross-links DNA base pairs, leading to breakages and triggering apoptosis in haematopoietic cells.</td>

<td>Vomiting, myelosuppression, <a href="Haemorrhagic_cystitis" class="mw-redirect" title="Haemorrhagic cystitis">haemorrhagic cystitis</a> and rarely heart failure, pulmonary fibrosis, <a href="Hepatic_sinusoidal_obstruction_syndrome" class="mw-redirect" title="Hepatic sinusoidal obstruction syndrome">hepatic sinusoidal obstruction syndrome</a>, malignancy and <a href="Syndrome_of_inappropriate_secretion_of_antidiuretic_hormone" class="mw-redirect" title="Syndrome of inappropriate secretion of antidiuretic hormone">SIADH</a>

</td></tr>

<tr>

<td><a href="Dasatinib" title="Dasatinib">Dasatinib</a></td>

<td><a href="Tyrosine_kinase" title="Tyrosine kinase">Tyrosine kinase</a> inhibitor against various proangiogenic growth factors (including PDGF and VEGF).</td>

<td>Fluid retention, myelosuppression, haemorrhage, infections, pulmonary hypertension, electrolyte anomalies and uncommonly hepatotoxicity, heart dysfunction/failure, myocardial infarction, QT interval prolongation, renal failure and hypersensitivity.

</td></tr>

<tr>

<td><a href="Imatinib" title="Imatinib">Imatinib</a></td>

<td>As above</td>

<td>As above and rarely: GI perforation, avascular necrosis and <a href="Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a>

</td></tr>

<tr>

<td><a href="Immunoglobulin" class="mw-redirect" title="Immunoglobulin">Immunoglobulin</a></td>

<td>Immunoglobulin, modulates the immune system.</td>

<td>Varies

</td></tr>

<tr>

<td><a href="Methotrexate" title="Methotrexate">Methotrexate</a></td>

<td>Antifolate; inhibits <a href="Dihydrofolate_reductase" title="Dihydrofolate reductase">dihydrofolate reductase</a>.</td>

<td>Myelosuppression, pulmonary toxicity, hepatotoxicity, neurotoxicity, and rarely kidney failure, hypersensitivity reactions, skin and bone necrosis, and osteoporosis

</td></tr>

<tr>

<td><a href="Mycophenolate" class="mw-redirect" title="Mycophenolate">Mycophenolate</a></td>

<td><a href="Inosine_monophosphate_dehydrogenase" class="mw-redirect" title="Inosine monophosphate dehydrogenase">Inosine monophosphate dehydrogenase</a> inhibitor, leading to reduced purine biosynthesis in lymphocytes.</td>

<td>Myelosuppression, blood clots, less commonly GI perforation/haemorrhage and rarely <a href="Pancreatitis" title="Pancreatitis">pancreatitis</a>, <a href="Hepatitis" title="Hepatitis">hepatitis</a>, <a href="Aplastic_anaemia" class="mw-redirect" title="Aplastic anaemia">aplastic anaemia</a> and <a href="Pure_red_cell_aplasia" title="Pure red cell aplasia">pure red cell aplasia</a>.

</td></tr>

<tr>

<td><a href="Nilotinib" title="Nilotinib">Nilotinib</a></td>

<td>As per dasatinib</td>

<td>As per imatinib

</td></tr>

<tr>

<td><a href="Rituximab" title="Rituximab">Rituximab</a></td>

<td>Monoclonal antibody against <a href="CD20" title="CD20">CD20</a>, which is expressed on B lymphocytes</td>

<td>Infusion-related reactions, infection, <a href="Neutropenia" title="Neutropenia">neutropenia</a>, reduced immunoglobulin levels, arrhythmias, less commonly anaemia, thrombocytopenia, angina, myocardial infarction, heart failure, and rarely <a href="Haemolytic_anaemia" class="mw-redirect" title="Haemolytic anaemia">haemolytic anaemia</a>, <a href="Aplastic_anaemia" class="mw-redirect" title="Aplastic anaemia">aplastic anaemia</a>, serum sickness, severe skin conditions, pulmonary infiltrates, <a href="Pneumonitis" title="Pneumonitis">pneumonitis</a>, cranial neuropathy (vision or hearing loss) and <a href="Progressive_multifocal_leucoencephalopathy" class="mw-redirect" title="Progressive multifocal leucoencephalopathy">progressive multifocal leucoencephalopathy</a>.

</td></tr>

<tr>

<td><a href="Sirolimus" title="Sirolimus">Sirolimus</a></td>

<td><a href="Mammalian_target_of_rapamycin" class="mw-redirect" title="Mammalian target of rapamycin">mTOR</a> inhibitor, thereby reducing cytokine-induced lymphocyte proliferation.</td>

<td><a href="Neutropenia" title="Neutropenia">Neutropenia</a>, <a href="Hypokalaemia" class="mw-redirect" title="Hypokalaemia">hypokalaemia</a>, interstitial lung disease, <a href="Pericardial_effusion" title="Pericardial effusion">pericardial effusion</a>, <a href="Pleural_effusion" title="Pleural effusion">pleural effusion</a>, less commonly pulmonary haemorrhage, nephrotic syndrome, and rarely hepatotoxicity and <a href="Lymphoedema" class="mw-redirect" title="Lymphoedema">lymphoedema</a>.

</td></tr>

<tr>

<td colspan="5">PO = Oral. IV = Intravenous. IM = Intramuscular. SC = Subcutaneous. IT = Intrathecal.

The preferred pregnancy category, above, is Australian, if available. If unavailable, an American one is substituted.

</td></tr></tbody></table>

<div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2></div>

As of 2012, the five-year survival rate for systemic scleroderma was about 85%, whereas the 10-year survival rate was just under 70%.<a href="#cite_note-germ-44">[44]</a> This varies according to the subtype; while localized scleroderma rarely results in death, the systemic form can, and the diffuse systemic form carries a worse prognosis than the limited form. The major scleroderma-related causes of death are: <a href="Pulmonary_hypertension" title="Pulmonary hypertension">pulmonary hypertension</a>, <a href="Pulmonary_fibrosis" title="Pulmonary fibrosis">pulmonary fibrosis</a>, and scleroderma renal crisis.<a href="#cite_note-MSR-29">[29]</a> People with scleroderma are also at a heightened risk for developing osteoporosis and for contracting cancer (especially liver, lung, haematologic, and bladder cancers).<a href="#cite_note-45">[45]</a> Scleroderma is also associated with an increased risk of cardiovascular disease.<a href="#cite_note-46">[46]</a>

According to a study of an Australian cohort, between 1985 and 2015, the average life expectancy of a person with scleroderma increased from 66 years to 74 years (the average Australian life expectancy increased from 76 to 82 years in the same period).<a href="#cite_note-47">[47]</a>

<div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2></div>

Scleroderma most commonly first presents between the ages of 20 and 50 years, although any age group can be affected.<a href="#cite_note-MM-13">[13]</a><a href="#cite_note-MSR-29">[29]</a> Women are four to nine times more likely to develop scleroderma than men.<a href="#cite_note-MSR-29">[29]</a>

This disease is found worldwide.<a href="#cite_note-MSR-29">[29]</a> In the United States, prevalence is estimated at 240 per million, and the annual incidence of scleroderma is 19 per million people.<a href="#cite_note-MSR-29">[29]</a> Likewise, in the United States, it is slightly more common in <a href="African_American" class="mw-redirect" title="African American">African Americans</a> than in their white counterparts. Choctaw Native Americans are more likely than Americans of European descent to develop the type of scleroderma that affects internal organs.<a href="#cite_note-MSR-29">[29]</a> In <a href="Germany" title="Germany">Germany</a>, the prevalence is between 10 and 150 per million people, and the annual incidence is between three and 28 per million people.<a href="#cite_note-germ-44">[44]</a> In <a href="South_Australia" title="South Australia">South Australia</a>, the annual incidence is 23 per million people, and the prevalence 233 per million people.<a href="#cite_note-48">[48]</a>

<div class="mw-heading mw-heading2"><h2 id="Pregnancy">Pregnancy</h2></div>

Scleroderma in pregnancy is a complex situation; it increases the risk to both mother and child.<a href="#cite_note-preg-49">[49]</a> Overall, scleroderma is associated with reduced fetal weight for gestational age.<a href="#cite_note-preg-49">[49]</a> The treatment for scleroderma often includes known teratogens such as cyclophosphamide, methotrexate, <a href="Mycophenolate" class="mw-redirect" title="Mycophenolate">mycophenolate</a>, etc., so careful avoidance of such drugs during pregnancy is advised.<a href="#cite_note-preg-49">[49]</a> In these cases <a href="Hydroxychloroquine" title="Hydroxychloroquine">hydroxychloroquine</a> and low-dose <a href="Corticosteroid" title="Corticosteroid">corticosteroids</a> might be used for disease control.<a href="#cite_note-preg-49">[49]</a>

<ul><li><a href="Congenital_fascial_dystrophy" class="mw-redirect" title="Congenital fascial dystrophy">Congenital fascial dystrophy</a></li>

<li><a href="Chi_Chi_DeVayne" title="Chi Chi DeVayne">Chi Chi DeVayne</a>, (developed scleroderma in the years leading up to her death)</li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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</ol></div></div>

<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

<ul><li><a rel="nofollow" class="external text" href="https://www.niams.nih.gov/health-topics/scleroderma">Handout on Health: Scleroderma</a> – US National Institute of Arthritis and Musculoskeletal and Skin Diseases</li></ul>

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</style><div id="Diseases_of_the_skin_and_appendages_by_morphology95" style="font-size:114%;margin:0 4em">Diseases of the skin and appendages by morphology</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Growths</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Epidermis" title="Epidermis">Epidermal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<li><a href="Callus" title="Callus">Callus</a></li>

<li><a href="Seborrheic_keratosis" title="Seborrheic keratosis">Seborrheic keratosis</a></li>

<li><a href="Skin_tag" title="Skin tag">Acrochordon</a></li>

<li><a href="Molluscum_contagiosum" title="Molluscum contagiosum">Molluscum contagiosum</a></li>

<li><a href="Actinic_keratosis" title="Actinic keratosis">Actinic keratosis</a></li>

<li><a href="Squamous-cell_carcinoma" title="Squamous-cell carcinoma">Squamous-cell carcinoma</a></li>

<li><a href="Basal-cell_carcinoma" title="Basal-cell carcinoma">Basal-cell carcinoma</a></li>

<li><a href="Merkel-cell_carcinoma" title="Merkel-cell carcinoma">Merkel-cell carcinoma</a></li>

<li><a href="Nevus_sebaceous" title="Nevus sebaceous">Nevus sebaceous</a></li>

<li><a href="Trichoepithelioma" title="Trichoepithelioma">Trichoepithelioma</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pigmented</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Freckle" title="Freckle">Freckles</a></li>

<li><a href="Lentigo" title="Lentigo">Lentigo</a></li>

<li><a href="Melasma" title="Melasma">Melasma</a></li>

<li><a href="Nevus" title="Nevus">Nevus</a></li>

<li><a href="Melanoma" title="Melanoma">Melanoma</a></li>

<li><a href="Postinflammatory_hyperpigmentation" title="Postinflammatory hyperpigmentation">Postinflammatory hyperpigmentation</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Dermis" title="Dermis">Dermal</a> and subcutaneous</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Epidermoid_cyst" title="Epidermoid cyst">Epidermal inclusion cyst</a></li>

<li><a href="Hemangioma" title="Hemangioma">Hemangioma</a></li>

<li><a href="Benign_fibrous_histiocytoma" class="mw-redirect" title="Benign fibrous histiocytoma">Dermatofibroma (benign fibrous histiocytoma)</a></li>

<li><a href="Keloid" title="Keloid">Keloid</a></li>

<li><a href="Lipoma" title="Lipoma">Lipoma</a></li>

<li><a href="Neurofibroma" title="Neurofibroma">Neurofibroma</a></li>

<li><a href="Xanthoma" title="Xanthoma">Xanthoma</a></li>

<li><a href="Kaposi's_sarcoma" title="Kaposi's sarcoma">Kaposi's sarcoma</a></li>

<li><a href="Infantile_digital_fibromatosis" title="Infantile digital fibromatosis">Infantile digital fibromatosis</a></li>

<li><a href="Granular_cell_tumor" title="Granular cell tumor">Granular cell tumor</a></li>

<li><a href="Leiomyoma" title="Leiomyoma">Leiomyoma</a></li>

<li><a href="Lymphangioma_circumscriptum" title="Lymphangioma circumscriptum">Lymphangioma circumscriptum</a></li>

<li><a href="Myxoid_cyst" title="Myxoid cyst">Myxoid cyst</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Rash" title="Rash">Rashes</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">With epidermal involvement</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Eczematous</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Contact_dermatitis" title="Contact dermatitis">Contact dermatitis</a></li>

<li><a href="Atopic_dermatitis" title="Atopic dermatitis">Atopic dermatitis</a></li>

<li><a href="Seborrhoeic_dermatitis" title="Seborrhoeic dermatitis">Seborrheic dermatitis</a></li>

<li><a href="Stasis_dermatitis" title="Stasis dermatitis">Stasis dermatitis</a></li>

<li><a href="Lichen_simplex_chronicus" title="Lichen simplex chronicus">Lichen simplex chronicus</a></li>

<li><a href="Darier's_disease" title="Darier's disease">Darier's disease</a></li>

<li><a href="Glucagonoma_syndrome" class="mw-redirect" title="Glucagonoma syndrome">Glucagonoma syndrome</a></li>

<li><a href="Langerhans_cell_histiocytosis" title="Langerhans cell histiocytosis">Langerhans cell histiocytosis</a></li>

<li><a href="Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosus</a></li>

<li><a href="Pemphigus" title="Pemphigus">Pemphigus foliaceus</a></li>

<li><a href="Wiskott%E2%80%93Aldrich_syndrome" title="Wiskott–Aldrich syndrome">Wiskott–Aldrich syndrome</a></li>

<li><a href="Zinc_deficiency" title="Zinc deficiency">Zinc deficiency</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Scale_(dermatology)" class="mw-redirect" title="Scale (dermatology)">Scaling</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Psoriasis" title="Psoriasis">Psoriasis</a></li>

<li>Tinea (<a href="Tinea_corporis" title="Tinea corporis">Corporis</a></li>

<li><a href="Tinea_cruris" title="Tinea cruris">Cruris</a></li>

<li><a href="Athlete's_foot" title="Athlete's foot">Pedis</a></li>

<li><a href="Tinea_manuum" title="Tinea manuum">Manuum</a></li>

<li><a href="Tinea_faciei" title="Tinea faciei">Faciei</a>)</li>

<li><a href="Pityriasis_rosea" title="Pityriasis rosea">Pityriasis rosea</a></li>

<li><a href="Syphilis" title="Syphilis">Secondary syphilis</a></li>

<li><a href="Mycosis_fungoides" title="Mycosis fungoides">Mycosis fungoides</a></li>

<li><a href="Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li>

<li><a href="Pityriasis_rubra_pilaris" title="Pityriasis rubra pilaris">Pityriasis rubra pilaris</a></li>

<li><a href="Parapsoriasis" title="Parapsoriasis">Parapsoriasis</a></li>

<li><a href="Ichthyosis" title="Ichthyosis">Ichthyosis</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Blister" title="Blister">Blistering</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Herpes" title="Herpes">Herpes simplex</a></li>

<li><a href="Herpes_zoster" class="mw-redirect" title="Herpes zoster">Herpes zoster</a></li>

<li><a href="Chickenpox" title="Chickenpox">Varicella</a></li>

<li><a href="Impetigo" title="Impetigo">Bullous impetigo</a></li>

<li><a href="Contact_dermatitis" title="Contact dermatitis">Acute contact dermatitis</a></li>

<li><a href="Pemphigus_vulgaris" title="Pemphigus vulgaris">Pemphigus vulgaris</a></li>

<li><a href="Bullous_pemphigoid" title="Bullous pemphigoid">Bullous pemphigoid</a></li>

<li><a href="Dermatitis_herpetiformis" title="Dermatitis herpetiformis">Dermatitis herpetiformis</a></li>

<li><a href="Porphyria_cutanea_tarda" title="Porphyria cutanea tarda">Porphyria cutanea tarda</a></li>

<li><a href="Epidermolysis_bullosa_simplex" title="Epidermolysis bullosa simplex">Epidermolysis bullosa simplex</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Papule" title="Papule">Papular</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Scabies" title="Scabies">Scabies</a></li>

<li><a href="Insect_bites_and_stings" class="mw-redirect" title="Insect bites and stings">Insect bite reactions</a></li>

<li><a href="Lichen_planus" title="Lichen planus">Lichen planus</a></li>

<li><a href="Miliaria" title="Miliaria">Miliaria</a></li>

<li><a href="Keratosis_pilaris" title="Keratosis pilaris">Keratosis pilaris</a></li>

<li><a href="Lichen_spinulosus" title="Lichen spinulosus">Lichen spinulosus</a></li>

<li><a href="Transient_acantholytic_dermatosis" title="Transient acantholytic dermatosis">Transient acantholytic dermatosis</a></li>

<li><a href="Lichen_nitidus" title="Lichen nitidus">Lichen nitidus</a></li>

<li><a href="Pityriasis_lichenoides_et_varioliformis_acuta" title="Pityriasis lichenoides et varioliformis acuta">Pityriasis lichenoides et varioliformis acuta</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Pustule" class="mw-redirect" title="Pustule">Pustular</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Acne_vulgaris" class="mw-redirect" title="Acne vulgaris">Acne vulgaris</a></li>

<li><a href="Rosacea" title="Rosacea">Rosacea</a></li>

<li><a href="Folliculitis" title="Folliculitis">Folliculitis</a></li>

<li><a href="Impetigo" title="Impetigo">Impetigo</a></li>

<li><a href="Candidiasis" title="Candidiasis">Candidiasis</a></li>

<li><a href="Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae">Gonococcemia</a></li>

<li><a href="Dermatophyte" title="Dermatophyte">Dermatophyte</a></li>

<li><a href="Coccidioidomycosis" title="Coccidioidomycosis">Coccidioidomycosis</a></li>

<li><a href="Subcorneal_pustular_dermatosis" class="mw-redirect" title="Subcorneal pustular dermatosis">Subcorneal pustular dermatosis</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Hypopigmented</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Tinea_versicolor" title="Tinea versicolor">Tinea versicolor</a></li>

<li><a href="Vitiligo" title="Vitiligo">Vitiligo</a></li>

<li><a href="Pityriasis_alba" title="Pityriasis alba">Pityriasis alba</a></li>

<li><a href="Tuberous_sclerosis" title="Tuberous sclerosis">Tuberous sclerosis</a></li>

<li><a href="Idiopathic_guttate_hypomelanosis" title="Idiopathic guttate hypomelanosis">Idiopathic guttate hypomelanosis</a></li>

<li><a href="Leprosy" title="Leprosy">Leprosy</a></li>

<li><a href="Mycosis_fungoides" title="Mycosis fungoides">Hypopigmented mycosis fungoides</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Without epidermal involvement</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Red12" scope="row" class="navbox-group" style="width:1%">Red</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Blanchable <a href="Erythema" title="Erythema">Erythema</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Generalized</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Drug_eruption" title="Drug eruption">Drug eruptions</a></li>

<li><a href="Exanthem" title="Exanthem">Viral exanthems</a></li>

<li><a href="Erythema_toxicum_neonatorum" title="Erythema toxicum neonatorum">Toxic erythema</a></li>

<li><a href="Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Localized</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Cellulitis" title="Cellulitis">Cellulitis</a></li>

<li><a href="Abscess" title="Abscess">Abscess</a></li>

<li><a href="Erythema_nodosum" title="Erythema nodosum">Erythema nodosum</a></li>

<li><a href="Carcinoid_syndrome" title="Carcinoid syndrome">Carcinoid syndrome</a></li>

<li><a href="Fixed_drug_eruption" class="mw-redirect" title="Fixed drug eruption">Fixed drug eruption</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Specialized</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Urticaria" class="mw-redirect" title="Urticaria">Urticaria</a></li>

<li>Erythema (<a href="Erythema_multiforme" title="Erythema multiforme">Multiforme</a></li>

<li><a href="Erythema_chronicum_migrans" class="mw-redirect" title="Erythema chronicum migrans">Migrans</a></li>

<li><a href="Erythema_gyratum_repens" title="Erythema gyratum repens">Gyratum repens</a></li>

<li><a href="Erythema_annulare_centrifugum" title="Erythema annulare centrifugum">Annulare centrifugum</a></li>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonblanchable Purpura</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Macular</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Thrombocytopenic_purpura" title="Thrombocytopenic purpura">Thrombocytopenic purpura</a></li>

<li><a href="Solar_purpura" title="Solar purpura">Actinic/solar purpura</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Papular</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">Disseminated intravascular coagulation</a></li>

<li><a href="Vasculitis" title="Vasculitis">Vasculitis</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Indurated</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li>/<a href="Morphea" title="Morphea">morphea</a></li>

<li><a href="Granuloma_annulare" title="Granuloma annulare">Granuloma annulare</a></li>

<li><a href="Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosis et atrophicus</a></li>

<li><a href="Necrobiosis_lipoidica" title="Necrobiosis lipoidica">Necrobiosis lipoidica</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Miscellaneous disorders</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Ulcer_(dermatology)" title="Ulcer (dermatology)">Ulcers</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Hair</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Telogen_effluvium" title="Telogen effluvium">Telogen effluvium</a></li>

<li><a href="Androgenic_alopecia" class="mw-redirect" title="Androgenic alopecia">Androgenic alopecia</a></li>

<li><a href="Alopecia_areata" title="Alopecia areata">Alopecia areata</a></li>

<li><a href="Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li>

<li><a href="Tinea_capitis" title="Tinea capitis">Tinea capitis</a></li>

<li><a href="Loose_anagen_syndrome" title="Loose anagen syndrome">Loose anagen syndrome</a></li>

<li><a href="Lichen_planopilaris" class="mw-redirect" title="Lichen planopilaris">Lichen planopilaris</a></li>

<li><a href="Folliculitis_decalvans" title="Folliculitis decalvans">Folliculitis decalvans</a></li>

<li><a href="Pseudofolliculitis_barbae" title="Pseudofolliculitis barbae">Acne keloidalis nuchae</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Nail_(anatomy)" title="Nail (anatomy)">Nail</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Onychomycosis" title="Onychomycosis">Onychomycosis</a></li>

<li><a href="Psoriasis" title="Psoriasis">Psoriasis</a></li>

<li><a href="Paronychia" title="Paronychia">Paronychia</a></li>

<li><a href="Ingrown_nail" title="Ingrown nail">Ingrown nail</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Mucous_membrane" title="Mucous membrane">Mucous membrane</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Aphthous_stomatitis" title="Aphthous stomatitis">Aphthous stomatitis</a></li>

<li><a href="Oral_candidiasis" title="Oral candidiasis">Oral candidiasis</a></li>

<li><a href="Lichen_planus" title="Lichen planus">Lichen planus</a></li>

<li><a href="Leukoplakia" title="Leukoplakia">Leukoplakia</a></li>

<li><a href="Pemphigus" title="Pemphigus">Pemphigus vulgaris</a></li>

<li><a href="Mucous_membrane_pemphigoid" title="Mucous membrane pemphigoid">Mucous membrane pemphigoid</a></li>

<li><a href="Cicatricial_pemphigoid" class="mw-redirect" title="Cicatricial pemphigoid">Cicatricial pemphigoid</a></li>

<li><a href="Herpesviridae" title="Herpesviridae">Herpesvirus</a></li>

<li><a href="Coxsackievirus" title="Coxsackievirus">Coxsackievirus</a></li>

<li><a href="Syphilis" title="Syphilis">Syphilis</a></li>

<li><a href="Histoplasmosis" title="Histoplasmosis">Systemic histoplasmosis</a></li>

<li><a href="Squamous-cell_carcinoma" title="Squamous-cell carcinoma">Squamous-cell carcinoma</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-labelledby="Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis176" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis176" style="font-size:114%;margin:0 4em">Cutaneous keratosis, ulcer, atrophy, and necrobiosis</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Acanthosis" class="mw-redirect" title="Acanthosis">Epidermal thickening</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Keratoderma" title="Keratoderma">keratoderma</a>: <a href="Keratoderma_climactericum" title="Keratoderma climactericum">Keratoderma climactericum</a></li>

<li><a href="Paraneoplastic_keratoderma" title="Paraneoplastic keratoderma">Paraneoplastic keratoderma</a>

<ul><li><a href="Paraneoplastic_acrokeratosis" title="Paraneoplastic acrokeratosis">Acrokeratosis paraneoplastica of Bazex</a></li></ul></li>

<li><a href="Palmoplantar_keratoderma" title="Palmoplantar keratoderma">Aquagenic keratoderma</a></li>

<li><a href="Drug-induced_keratoderma" title="Drug-induced keratoderma">Drug-induced keratoderma</a></li>

<li><a href="Psoriasis" title="Psoriasis">psoriasis</a>

<ul><li><a href="Keratoderma_blennorrhagicum" title="Keratoderma blennorrhagicum">Keratoderma blennorrhagicum</a></li></ul></li></ul>

<ul><li><a href="Keratosis" title="Keratosis">keratosis</a>: <a href="Seborrheic_keratosis" title="Seborrheic keratosis">Seborrheic keratosis</a>

<ul><li><a href="Clonal_seborrheic_keratosis" class="mw-redirect" title="Clonal seborrheic keratosis">Clonal seborrheic keratosis</a></li>

<li><a href="Common_seborrheic_keratosis" class="mw-redirect" title="Common seborrheic keratosis">Common seborrheic keratosis</a></li>

<li><a href="Irritated_seborrheic_keratosis" class="mw-redirect" title="Irritated seborrheic keratosis">Irritated seborrheic keratosis</a></li>

<li><a href="Seborrheic_keratosis_with_squamous_atypia" class="mw-redirect" title="Seborrheic keratosis with squamous atypia">Seborrheic keratosis with squamous atypia</a></li>

<li><a href="Reticulated_seborrheic_keratosis" class="mw-redirect" title="Reticulated seborrheic keratosis">Reticulated seborrheic keratosis</a></li>

<li><a href="Dermatosis_papulosa_nigra" title="Dermatosis papulosa nigra">Dermatosis papulosa nigra</a></li></ul></li>

<li><a href="Keratosis_punctata_of_the_palmar_creases" title="Keratosis punctata of the palmar creases">Keratosis punctata of the palmar creases</a></li></ul>

<ul><li>other <a href="Hyperkeratosis" title="Hyperkeratosis">hyperkeratosis</a>: <a href="Acanthosis_nigricans" title="Acanthosis nigricans">Acanthosis nigricans</a>

<ul><li><a href="Confluent_and_reticulated_papillomatosis" title="Confluent and reticulated papillomatosis">Confluent and reticulated papillomatosis</a></li></ul></li>

<li><a href="Callus" title="Callus">Callus</a></li>

<li><a href="Ichthyosis_acquisita" title="Ichthyosis acquisita">Ichthyosis acquisita</a></li>

<li><a href="Arsenical_keratosis" title="Arsenical keratosis">Arsenical keratosis</a></li>

<li><a href="Chronic_scar_keratosis" title="Chronic scar keratosis">Chronic scar keratosis</a></li>

<li><a href="Hyperkeratosis_lenticularis_perstans" class="mw-redirect" title="Hyperkeratosis lenticularis perstans">Hyperkeratosis lenticularis perstans</a></li>

<li><a href="Hydrocarbon_keratosis" title="Hydrocarbon keratosis">Hydrocarbon keratosis</a></li>

<li><a href="Hyperkeratosis_of_the_nipple_and_areola" class="mw-redirect" title="Hyperkeratosis of the nipple and areola">Hyperkeratosis of the nipple and areola</a></li>

<li><a href="Inverted_follicular_keratosis" class="mw-redirect" title="Inverted follicular keratosis">Inverted follicular keratosis</a></li>

<li><a href="Lichen_planus" title="Lichen planus">Lichenoid keratosis</a></li>

<li><a href="Multiple_minute_digitate_hyperkeratosis" title="Multiple minute digitate hyperkeratosis">Multiple minute digitate hyperkeratosis</a></li>

<li><a href="PUVA_keratosis" title="PUVA keratosis">PUVA keratosis</a></li>

<li><a href="Reactional_keratosis" title="Reactional keratosis">Reactional keratosis</a></li>

<li><a href="Stucco_keratosis" class="mw-redirect" title="Stucco keratosis">Stucco keratosis</a></li>

<li><a href="Thermal_keratosis" title="Thermal keratosis">Thermal keratosis</a></li>

<li><a href="Wart" title="Wart">Viral keratosis</a></li>

<li><a href="Warty_dyskeratoma" title="Warty dyskeratoma">Warty dyskeratoma</a></li>

<li><a href="Waxy_keratosis_of_childhood" title="Waxy keratosis of childhood">Waxy keratosis of childhood</a></li></ul>

<ul><li>other hypertrophy: <a href="Keloid" title="Keloid">Keloid</a></li>

<li><a href="Hypertrophic_scar" title="Hypertrophic scar">Hypertrophic scar</a></li>

<li><a href="Cutis_verticis_gyrata" title="Cutis verticis gyrata">Cutis verticis gyrata</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Necrobiosis" title="Necrobiosis">Necrobiosis</a>/<a href="Granuloma" title="Granuloma">granuloma</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Granuloma#Necrobiotic/palisading" title="Granuloma">Necrobiotic/palisading</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Granuloma_annulare" title="Granuloma annulare">Granuloma annulare</a>

<ul><li><a href="Perforating_granuloma_annulare" title="Perforating granuloma annulare">Perforating</a></li>

<li><a href="Generalized_granuloma_annulare" title="Generalized granuloma annulare">Generalized</a></li>

<li><a href="Subcutaneous_granuloma_annulare" title="Subcutaneous granuloma annulare">Subcutaneous</a></li>

<li><a href="Granuloma_annulare_in_HIV_disease" class="mw-redirect" title="Granuloma annulare in HIV disease">Granuloma annulare in HIV disease</a></li>

<li><a href="Localized_granuloma_annulare" title="Localized granuloma annulare">Localized granuloma annulare</a></li>

<li><a href="Patch-type_granuloma_annulare" title="Patch-type granuloma annulare">Patch-type granuloma annulare</a></li></ul></li>

<li><a href="Necrobiosis_lipoidica" title="Necrobiosis lipoidica">Necrobiosis lipoidica</a></li>

<li><a href="Annular_elastolytic_giant-cell_granuloma" title="Annular elastolytic giant-cell granuloma">Annular elastolytic giant-cell granuloma</a></li>

<li><a href="Granuloma_multiforme" title="Granuloma multiforme">Granuloma multiforme</a></li>

<li><a href="Necrobiotic_xanthogranuloma" title="Necrobiotic xanthogranuloma">Necrobiotic xanthogranuloma</a></li>

<li><a href="Palisaded_neutrophilic_and_granulomatous_dermatitis" title="Palisaded neutrophilic and granulomatous dermatitis">Palisaded neutrophilic and granulomatous dermatitis</a></li>

<li><a href="Rheumatoid_nodulosis" title="Rheumatoid nodulosis">Rheumatoid nodulosis</a></li>

<li><a href="Interstitial_granulomatous_dermatitis_with_arthritis" title="Interstitial granulomatous dermatitis with arthritis">Interstitial granulomatous dermatitis</a>/<a href="Interstitial_granulomatous_drug_reaction" title="Interstitial granulomatous drug reaction">Interstitial granulomatous drug reaction</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Foreign_body_granuloma" class="mw-redirect" title="Foreign body granuloma">Foreign body granuloma</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Beryllium_granuloma" title="Beryllium granuloma">Beryllium granuloma</a></li>

<li><a href="Mercury_granuloma" title="Mercury granuloma">Mercury granuloma</a></li>

<li><a href="Silica_granuloma" title="Silica granuloma">Silica granuloma</a></li>

<li><a href="Silicone_granuloma" title="Silicone granuloma">Silicone granuloma</a></li>

<li><a href="Zirconium_granuloma" title="Zirconium granuloma">Zirconium granuloma</a></li>

<li><a href="Tattoo" title="Tattoo">Tattoo</a></li>

<li><a href="Carbon_stain" title="Carbon stain">Carbon stain</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other/ungrouped</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Eosinophilic_dermatosis" title="Eosinophilic dermatosis">eosinophilic dermatosis</a>

<ul><li><a href="Granuloma_faciale" title="Granuloma faciale">Granuloma faciale</a></li></ul></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Dermis" title="Dermis">Dermis</a>/ localized <a href="Connective_tissue_disease" title="Connective tissue disease">CTD</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Lupus_erythematosus" title="Lupus erythematosus">Cutaneous lupus erythematosus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li>chronic: <a href="Discoid_lupus_erythematosus" title="Discoid lupus erythematosus">Discoid</a></li>

<li><a href="Lupus_erythematosus_panniculitis" title="Lupus erythematosus panniculitis">Panniculitis</a></li></ul>

<ul><li><a href="Subacute_cutaneous_lupus_erythematosus" title="Subacute cutaneous lupus erythematosus">subacute</a>: <a href="Neonatal_lupus_erythematosus" title="Neonatal lupus erythematosus">Neonatal</a></li></ul>

<ul><li>ungrouped: <a href="Chilblain_lupus_erythematosus" title="Chilblain lupus erythematosus">Chilblain</a></li>

<li><a href="Lupus_erythematosus%E2%80%93lichen_planus_overlap_syndrome" class="mw-redirect" title="Lupus erythematosus–lichen planus overlap syndrome">Lupus erythematosus–lichen planus overlap syndrome</a></li>

<li><a href="Tumid_lupus_erythematosus" title="Tumid lupus erythematosus">Tumid</a></li>

<li><a href="Verrucous_lupus_erythematosus" title="Verrucous lupus erythematosus">Verrucous</a></li>

<li><a href="Rowell's_syndrome" title="Rowell's syndrome">Rowell's syndrome</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">/ <a href="Morphea" title="Morphea">Morphea</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Localized_scleroderma" class="mw-redirect" title="Localized scleroderma">Localized scleroderma</a>

<ul><li><a href="Localized_morphea" class="mw-redirect" title="Localized morphea">Localized morphea</a></li>

<li><a href="Morphea%E2%80%93lichen_sclerosus_et_atrophicus_overlap" class="mw-redirect" title="Morphea–lichen sclerosus et atrophicus overlap">Morphea–lichen sclerosus et atrophicus overlap</a></li>

<li><a href="Generalized_morphea" class="mw-redirect" title="Generalized morphea">Generalized morphea</a></li>

<li><a href="Atrophoderma_of_Pasini_and_Pierini" class="mw-redirect" title="Atrophoderma of Pasini and Pierini">Atrophoderma of Pasini and Pierini</a></li>

<li><a href="Pansclerotic_morphea" class="mw-redirect" title="Pansclerotic morphea">Pansclerotic morphea</a></li>

<li><a href="Morphea_profunda" class="mw-redirect" title="Morphea profunda">Morphea profunda</a></li>

<li><a href="Linear_scleroderma" class="mw-redirect" title="Linear scleroderma">Linear scleroderma</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Atrophy" title="Atrophy">Atrophic</a>/ <a href="Atrophoderma" title="Atrophoderma">atrophoderma</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosus</a></li>

<li><a href="Anetoderma" title="Anetoderma">Anetoderma</a>

<ul><li><a href="Schweninger%E2%80%93Buzzi_anetoderma" class="mw-redirect" title="Schweninger–Buzzi anetoderma">Schweninger–Buzzi anetoderma</a></li>

<li><a href="Jadassohn%E2%80%93Pellizzari_anetoderma" class="mw-redirect" title="Jadassohn–Pellizzari anetoderma">Jadassohn–Pellizzari anetoderma</a></li></ul></li>

<li><a href="Atrophoderma_of_Pasini_and_Pierini" class="mw-redirect" title="Atrophoderma of Pasini and Pierini">Atrophoderma of Pasini and Pierini</a></li>

<li><a href="Acrodermatitis_chronica_atrophicans" title="Acrodermatitis chronica atrophicans">Acrodermatitis chronica atrophicans</a></li>

<li><a href="Lipoatrophia_semicircularis" title="Lipoatrophia semicircularis">Semicircular lipoatrophy</a></li>

<li><a href="Follicular_atrophoderma" title="Follicular atrophoderma">Follicular atrophoderma</a></li>

<li><a href="Linear_atrophoderma_of_Moulin" title="Linear atrophoderma of Moulin">Linear atrophoderma of Moulin</a></li>

<li><a href="Atrophia_maculosa_varioliformis_cutis" title="Atrophia maculosa varioliformis cutis">Atrophia maculosa varioliformis cutis</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Cutaneous_perforating_disorders" title="Cutaneous perforating disorders">Perforating</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Kyrle_disease" title="Kyrle disease">Kyrle disease</a></li>

<li><a href="Reactive_perforating_collagenosis" title="Reactive perforating collagenosis">Reactive perforating collagenosis</a></li>

<li><a href="Elastosis_perforans_serpiginosa" title="Elastosis perforans serpiginosa">Elastosis perforans serpiginosa</a></li>

<li><a href="Perforating_folliculitis" title="Perforating folliculitis">Perforating folliculitis</a></li>

<li><a href="Acquired_perforating_dermatosis" title="Acquired perforating dermatosis">Acquired perforating dermatosis</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Ulcer_(dermatology)" title="Ulcer (dermatology)">Skin ulcer</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Pyoderma_gangrenosum" title="Pyoderma gangrenosum">Pyoderma gangrenosum</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Calcinosis_cutis" title="Calcinosis cutis">Calcinosis cutis</a></li>

<li><a href="Sclerodactyly" title="Sclerodactyly">Sclerodactyly</a></li>

<li><a href="Poikiloderma_vasculare_atrophicans" title="Poikiloderma vasculare atrophicans">Poikiloderma vasculare atrophicans</a></li>

<li><a href="Ainhum" title="Ainhum">Ainhum</a>/<a href="Pseudo-ainhum" class="mw-redirect" title="Pseudo-ainhum">Pseudo-ainhum</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-labelledby="Systemic_connective_tissue_disorders138" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Systemic_connective_tissue_disorders138" style="font-size:114%;margin:0 4em">Systemic <a href="Connective_tissue_disease" title="Connective tissue disease">connective tissue disorders</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Drug-induced_lupus_erythematosus" title="Drug-induced lupus erythematosus">Drug-induced SLE</a></li>

<li><a href="Libman%E2%80%93Sacks_endocarditis" title="Libman–Sacks endocarditis">Libman–Sacks endocarditis</a></li>

<li><a href="Lupus_nephritis" title="Lupus nephritis">Lupus nephritis</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Inflammatory_myopathy" title="Inflammatory myopathy">Inflammatory myopathy</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Myositis" title="Myositis">Myositis</a></li>

<li><a href="Dermatopolymyositis" title="Dermatopolymyositis">Dermatopolymyositis</a>

<ul><li><a href="Dermatomyositis" title="Dermatomyositis">Dermatomyositis</a>/<a href="Juvenile_dermatomyositis" title="Juvenile dermatomyositis">Juvenile dermatomyositis</a></li>

<li><a href="Polymyositis" title="Polymyositis">Polymyositis</a>* <a href="Inclusion_body_myositis" title="Inclusion body myositis">Inclusion body myositis</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Systemic_scleroderma" title="Systemic scleroderma">Systemic scleroderma</a>

<ul><li><a href="Progressive_systemic_sclerosis" class="mw-redirect" title="Progressive systemic sclerosis">Progressive systemic sclerosis</a></li>

<li><a href="CREST_syndrome" title="CREST syndrome">CREST syndrome</a></li></ul></li></ul>

</div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Overlap_syndrome" title="Overlap syndrome">Overlap syndrome</a> / <a href="Mixed_connective_tissue_disease" title="Mixed connective tissue disease">Mixed connective tissue disease</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other <a href="Hypersensitivity" title="Hypersensitivity">hypersensitivity</a>/<a href="Autoimmune_disease" title="Autoimmune disease">autoimmune</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Sj%C3%B6gren_syndrome" class="mw-redirect" title="Sjögren syndrome">Sjögren syndrome</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="IgG4-related_disease" title="IgG4-related disease">IgG4-related disease</a></li>

<li><a href="Beh%C3%A7et's_disease" title="Behçet's disease">Behçet's disease</a></li>

<li><a href="Polymyalgia_rheumatica" title="Polymyalgia rheumatica">Polymyalgia rheumatica</a></li>

<li><a href="Eosinophilic_fasciitis" title="Eosinophilic fasciitis">Eosinophilic fasciitis</a></li>

<li><a href="Eosinophilia%E2%80%93myalgia_syndrome" title="Eosinophilia–myalgia syndrome">Eosinophilia–myalgia syndrome</a></li>

<li><a href="Ehlers%E2%80%93Danlos_syndrome" title="Ehlers–Danlos syndrome">Ehlers–Danlos syndrome</a></li>

<li><a href="Fibrillin" title="Fibrillin">fibrillin</a>

<ul><li><a href="Marfan_syndrome" title="Marfan syndrome">Marfan syndrome</a></li>

<li><a href="Congenital_contractural_arachnodactyly" title="Congenital contractural arachnodactyly">Congenital contractural arachnodactyly</a></li></ul></li></ul>

</div></td></tr></tbody></table></div>

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