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class="vector-toc-numb">2</span> <span>Cause</span> </div> </a> <ul id="toc-Cause-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Differential" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Differential</span> </div> </a> <ul id="toc-Differential-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Classification" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Classification"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Classification</span> </div> </a> <ul id="toc-Classification-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Prognosis</span> </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pregnancy" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pregnancy"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Pregnancy</span> </div> </a> <ul id="toc-Pregnancy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Scleroderma</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 43 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-43" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">43 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-als mw-list-item"><a href="https://als.wikipedia.org/wiki/Sklerodermie" title="Sklerodermie – Alemannic" lang="gsw" hreflang="gsw" data-title="Sklerodermie" data-language-autonym="Alemannisch" data-language-local-name="Alemannic" class="interlanguage-link-target"><span>Alemannisch</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AA%D8%B5%D9%84%D8%A8_%D8%A7%D9%84%D8%AC%D9%84%D8%AF" title="تصلب الجلد – Arabic" lang="ar" hreflang="ar" data-title="تصلب الجلد" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Sklerodermiya" title="Sklerodermiya – Azerbaijani" lang="az" hreflang="az" data-title="Sklerodermiya" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D8%A7%DB%8C%D8%B3%DA%A9%D9%84%D8%A6%D8%B1%D9%88%D8%AF%D8%A6%D8%B1%D9%85%D8%A7" title="ایسکلئرودئرما – South Azerbaijani" lang="azb" hreflang="azb" data-title="ایسکلئرودئرما" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A1%D0%BA%D0%BB%D0%B5%D1%80%D0%BE%D0%B4%D0%B5%D1%80%D0%BC%D0%B0" title="Склеродерма – Bulgarian" lang="bg" hreflang="bg" data-title="Склеродерма" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Esclerod%C3%A8rmia" title="Esclerodèrmia – Catalan" lang="ca" hreflang="ca" data-title="Esclerodèrmia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Sklerodermie" title="Sklerodermie – Czech" lang="cs" hreflang="cs" data-title="Sklerodermie" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Dermatosklerose" title="Dermatosklerose – German" lang="de" hreflang="de" data-title="Dermatosklerose" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A3%CE%BA%CE%BB%CE%B7%CF%81%CF%8C%CE%B4%CE%B5%CF%81%CE%BC%CE%B1" title="Σκληρόδερμα – Greek" lang="el" hreflang="el" data-title="Σκληρόδερμα" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Esclerodermia" title="Esclerodermia – Spanish" lang="es" hreflang="es" data-title="Esclerodermia" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Esklerodermia" title="Esklerodermia – Basque" lang="eu" hreflang="eu" data-title="Esklerodermia" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%B3%DA%A9%D9%84%D8%B1%D9%88%D8%AF%D8%B1%D9%85%DB%8C" title="اسکلرودرمی – Persian" lang="fa" hreflang="fa" data-title="اسکلرودرمی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Scl%C3%A9rodermie" title="Sclérodermie – French" lang="fr" hreflang="fr" data-title="Sclérodermie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Scl%C3%A9irideirm" title="Scléirideirm – Irish" lang="ga" hreflang="ga" data-title="Scléirideirm" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%94%BC%EB%B6%80%EA%B2%BD%ED%99%94%EC%A6%9D" title="피부경화증 – Korean" lang="ko" hreflang="ko" data-title="피부경화증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8D%D5%AF%D5%AC%D5%A5%D6%80%D5%B8%D5%A4%D5%A5%D6%80%D5%B4%D5%AB%D5%A1" title="Սկլերոդերմիա – Armenian" lang="hy" hreflang="hy" data-title="Սկլերոդերմիա" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B8%E0%A5%8D%E0%A4%95%E0%A5%8D%E0%A4%B2%E0%A5%87%E0%A4%B0%E0%A5%8B%E0%A4%A6%E0%A5%87%E0%A4%B0%E0%A5%8D%E0%A4%AE%E0%A4%BE" title="स्क्लेरोदेर्मा – Hindi" lang="hi" hreflang="hi" data-title="स्क्लेरोदेर्मा" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Skleroderma" title="Skleroderma – Croatian" lang="hr" hreflang="hr" data-title="Skleroderma" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Skleroderma" title="Skleroderma – Indonesian" lang="id" hreflang="id" data-title="Skleroderma" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Sclerodermia" title="Sclerodermia – Italian" lang="it" hreflang="it" data-title="Sclerodermia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A1%D7%A7%D7%9C%D7%A8%D7%95%D7%93%D7%A8%D7%9E%D7%94" title="סקלרודרמה – Hebrew" lang="he" hreflang="he" data-title="סקלרודרמה" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%A1%D0%BA%D0%BB%D0%B5%D1%80%D0%BE%D0%B4%D0%B5%D1%80%D0%BC%D0%B8%D1%8F" title="Склеродермия – Kyrgyz" lang="ky" hreflang="ky" data-title="Склеродермия" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Sklerodermija" title="Sklerodermija – Latvian" lang="lv" hreflang="lv" data-title="Sklerodermija" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Ank%C5%A1ten%C4%97" title="Ankštenė – Lithuanian" lang="lt" hreflang="lt" data-title="Ankštenė" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-lfn mw-list-item"><a href="https://lfn.wikipedia.org/wiki/Scleroderma" title="Scleroderma – Lingua Franca Nova" lang="lfn" hreflang="lfn" data-title="Scleroderma" data-language-autonym="Lingua Franca Nova" data-language-local-name="Lingua Franca Nova" class="interlanguage-link-target"><span>Lingua Franca Nova</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Szkleroderma" title="Szkleroderma – Hungarian" lang="hu" hreflang="hu" data-title="Szkleroderma" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Sclerodermie" title="Sclerodermie – Dutch" lang="nl" hreflang="nl" data-title="Sclerodermie" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%BC%B7%E7%9A%AE%E7%97%87" title="強皮症 – Japanese" lang="ja" hreflang="ja" data-title="強皮症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B8%E0%AD%8D%E0%AC%95%E0%AD%8D%E0%AC%B2%E0%AD%87%E0%AC%B0%E0%AD%8B%E0%AC%A1%E0%AC%B0%E0%AD%8D%E0%AC%AE%E0%AC%BE" title="ସ୍କ୍ଲେରୋଡର୍ମା – Odia" lang="or" hreflang="or" data-title="ସ୍କ୍ଲେରୋଡର୍ମା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Sklerodermiya" title="Sklerodermiya – Uzbek" lang="uz" hreflang="uz" data-title="Sklerodermiya" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Twardzina" title="Twardzina – Polish" lang="pl" hreflang="pl" data-title="Twardzina" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Esclerodermia" title="Esclerodermia – Portuguese" lang="pt" hreflang="pt" data-title="Esclerodermia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Scleroderma" title="Scleroderma – Romanian" lang="ro" hreflang="ro" data-title="Scleroderma" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Sklerodermia" title="Sklerodermia – Albanian" lang="sq" hreflang="sq" data-title="Sklerodermia" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Sklerodermia" title="Sklerodermia – Slovak" lang="sk" hreflang="sk" data-title="Sklerodermia" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%D8%B3%DA%A9%D9%84%DB%8E%D8%B1%DB%86%D8%AF%D8%B1%D9%85%D8%A7" title="سکلێرۆدرما – Central Kurdish" lang="ckb" hreflang="ckb" data-title="سکلێرۆدرما" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target"><span>کوردی</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A1%D0%BA%D0%BB%D0%B5%D1%80%D0%BE%D0%B4%D0%B5%D1%80%D0%BC%D0%B0" title="Склеродерма – Serbian" lang="sr" hreflang="sr" data-title="Склеродерма" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Skleroderma" title="Skleroderma – Finnish" lang="fi" hreflang="fi" data-title="Skleroderma" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Sklerodermi" title="Sklerodermi – Swedish" lang="sv" hreflang="sv" data-title="Sklerodermi" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%AB%E0%B8%99%E0%B8%B1%E0%B8%87%E0%B9%81%E0%B8%82%E0%B9%87%E0%B8%87" title="โรคหนังแข็ง – Thai" lang="th" hreflang="th" data-title="โรคหนังแข็ง" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Skleroderma" title="Skleroderma – Turkish" lang="tr" hreflang="tr" data-title="Skleroderma" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-yi mw-list-item"><a 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.hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">This article is about the disease. For the mushroom, see <a href="/wiki/Scleroderma_(fungus)" title="Scleroderma (fungus)">Scleroderma (fungus)</a>.</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="/wiki/Scleredema" title="Scleredema">scleredema</a>.</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Scleroderma</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:MercMorphea.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/71/MercMorphea.JPG/220px-MercMorphea.JPG" decoding="async" width="220" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/71/MercMorphea.JPG/330px-MercMorphea.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/71/MercMorphea.JPG/440px-MercMorphea.JPG 2x" data-file-width="1205" data-file-height="1191" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">A type of localized scleroderma known as <a href="/wiki/Morphea" title="Morphea">morphea</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Middle age<sup id="cite_ref-NORD2007_1-0" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data">Localized, <a href="/wiki/Systemic_scleroderma" title="Systemic scleroderma">systemic scleroderma</a><sup id="cite_ref-GARD2017_2-0" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">Unknown<sup id="cite_ref-GARD2017_2-1" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Family history, certain <a href="/wiki/Genetics" title="Genetics">genetic</a> factors, exposure to <a href="/wiki/Silica" class="mw-redirect" title="Silica">silica</a><sup id="cite_ref-Har2018_3-0" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Bar2012_4-0" class="reference"><a href="#cite_note-Bar2012-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gre2013_5-0" class="reference"><a href="#cite_note-Gre2013-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms, <a href="/wiki/Skin_biopsy" title="Skin biopsy">skin biopsy</a>, blood tests<sup id="cite_ref-NIH2016_6-0" class="reference"><a href="#cite_note-NIH2016-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Mixed_connective_tissue_disease" title="Mixed connective tissue disease">Mixed connective tissue disease</a>, <a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">systemic lupus erythematosus</a>, <a href="/wiki/Polymyositis" title="Polymyositis">polymyositis</a>, <a href="/wiki/Dermatomyositis" title="Dermatomyositis">dermatomyositis</a><sup id="cite_ref-NORD2007_1-1" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Supportive_care" class="mw-redirect" title="Supportive care">Supportive care</a><sup id="cite_ref-NORD2007_1-2" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Corticosteroids" class="mw-redirect" title="Corticosteroids">Corticosteroids</a>, <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, <a href="/wiki/Non-steroidal_anti-inflammatory_drugs" class="mw-redirect" title="Non-steroidal anti-inflammatory drugs">non-steroidal anti-inflammatory drugs</a> (NSAIDs)<sup id="cite_ref-GARD2017_2-2" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data"><b>Localized</b>: Normal life expectancy<sup id="cite_ref-Un2006_7-0" class="reference"><a href="#cite_note-Un2006-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><br /><b>Systemic</b>: Decreased life expectancy<sup id="cite_ref-Har2018_3-1" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">3 per 100,000 per year (systemic)<sup id="cite_ref-Har2018_3-2" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Scleroderma</b> is a group of <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune diseases</a> that may result in changes to the <a href="/wiki/Human_skin" title="Human skin">skin</a>, <a href="/wiki/Blood_vessels" class="mw-redirect" title="Blood vessels">blood vessels</a>, <a href="/wiki/Muscles" class="mw-redirect" title="Muscles">muscles</a>, and <a href="/wiki/Internal_organ" class="mw-redirect" title="Internal organ">internal organs</a>.<sup id="cite_ref-GARD2017_2-3" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-NIH2016_6-1" class="reference"><a href="#cite_note-NIH2016-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> The disease can be either localized to the skin or involve other organs, as well.<sup id="cite_ref-GARD2017_2-4" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Symptoms may include areas of thickened skin, stiffness, feeling tired, and poor blood flow to the fingers or toes with cold exposure.<sup id="cite_ref-NORD2007_1-3" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> One form of the condition, known as <a href="/wiki/CREST_syndrome" title="CREST syndrome">CREST syndrome</a>, classically results in <a href="/wiki/Calcinosis" title="Calcinosis">calcium deposits</a>, <a href="/wiki/Raynaud%27s_syndrome" class="mw-redirect" title="Raynaud's syndrome">Raynaud's syndrome</a>, <a href="/wiki/Esophagus" title="Esophagus">esophageal</a> problems, <a href="/wiki/Sclerodactyly" title="Sclerodactyly">thickening of the skin of the fingers and toes</a>, and <a href="/wiki/Telangiectasia" title="Telangiectasia">areas of small, dilated blood vessels</a>.<sup id="cite_ref-NORD2007_1-4" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>The cause is unknown, but it may be due to an abnormal immune response.<sup id="cite_ref-GARD2017_2-5" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Risk factors include family history, certain <a href="/wiki/Genetics" title="Genetics">genetic</a> factors, and exposure to <a href="/wiki/Silica" class="mw-redirect" title="Silica">silica</a>.<sup id="cite_ref-Har2018_3-3" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Bar2012_4-1" class="reference"><a href="#cite_note-Bar2012-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gre2013_5-1" class="reference"><a href="#cite_note-Gre2013-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The underlying mechanism involves the abnormal growth of <a href="/wiki/Connective_tissue" title="Connective tissue">connective tissue</a>, which is believed to be the result of the immune system attacking healthy tissues.<sup id="cite_ref-NIH2016_6-2" class="reference"><a href="#cite_note-NIH2016-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Diagnosis is based on symptoms, supported by a <a href="/wiki/Skin_biopsy" title="Skin biopsy">skin biopsy</a> or blood tests.<sup id="cite_ref-NIH2016_6-3" class="reference"><a href="#cite_note-NIH2016-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>While no cure is known, treatment may improve symptoms.<sup id="cite_ref-GARD2017_2-6" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Medications used include <a href="/wiki/Corticosteroids" class="mw-redirect" title="Corticosteroids">corticosteroids</a>, <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, and <a href="/wiki/Non-steroidal_anti-inflammatory_drugs" class="mw-redirect" title="Non-steroidal anti-inflammatory drugs">non-steroidal anti-inflammatory drugs</a> (NSAIDs).<sup id="cite_ref-GARD2017_2-7" class="reference"><a href="#cite_note-GARD2017-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Outcome depends on the extent of disease.<sup id="cite_ref-Har2018_3-4" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Those with localized disease generally have a normal <a href="/wiki/Life_expectancy" title="Life expectancy">life expectancy</a>.<sup id="cite_ref-Un2006_7-1" class="reference"><a href="#cite_note-Un2006-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> In those with systemic disease, life expectancy can be affected, and this varies based on subtype.<sup id="cite_ref-Har2018_3-5" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Death is often due to lung, gastrointestinal, or heart complications.<sup id="cite_ref-Har2018_3-6" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>About three per 100,000 people per year develop the systemic form.<sup id="cite_ref-Har2018_3-7" class="reference"><a href="#cite_note-Har2018-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The condition most often begins in middle age.<sup id="cite_ref-NORD2007_1-5" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Women are more often affected than men.<sup id="cite_ref-NORD2007_1-6" class="reference"><a href="#cite_note-NORD2007-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Scleroderma symptoms were first described in 1753 by Carlo Curzio<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> and then well documented in 1842.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The term is from the <a href="/wiki/Ancient_Greek" title="Ancient Greek">Greek</a> <i>skleros</i> meaning "hard" and <i>derma</i> meaning "skin".<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Left_Arm_Scleroderma_Patient.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/60/Left_Arm_Scleroderma_Patient.jpg/290px-Left_Arm_Scleroderma_Patient.jpg" decoding="async" width="290" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/60/Left_Arm_Scleroderma_Patient.jpg/435px-Left_Arm_Scleroderma_Patient.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/60/Left_Arm_Scleroderma_Patient.jpg/580px-Left_Arm_Scleroderma_Patient.jpg 2x" data-file-width="691" data-file-height="518" /></a><figcaption>Arm of a person with scleroderma showing skin lesions</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Systemic_sclerosis,_changes_on_hands_are_allways_bilateral.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Systemic_sclerosis%2C_changes_on_hands_are_allways_bilateral.jpg/290px-Systemic_sclerosis%2C_changes_on_hands_are_allways_bilateral.jpg" decoding="async" width="290" height="218" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Systemic_sclerosis%2C_changes_on_hands_are_allways_bilateral.jpg/435px-Systemic_sclerosis%2C_changes_on_hands_are_allways_bilateral.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Systemic_sclerosis%2C_changes_on_hands_are_allways_bilateral.jpg/580px-Systemic_sclerosis%2C_changes_on_hands_are_allways_bilateral.jpg 2x" data-file-width="1024" data-file-height="768" /></a><figcaption>Dark, shiny skin on distal phalanges of both hands in systemic sclerosis</figcaption></figure> <p>Potential signs and symptoms include:<sup id="cite_ref-MM_13-0" class="reference"><a href="#cite_note-MM-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PMSR_14-0" class="reference"><a href="#cite_note-PMSR-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Harrison_15-0" class="reference"><a href="#cite_note-Harrison-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Cardiovascular: <a href="/wiki/Raynaud%27s_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="/wiki/Ulcers" class="mw-redirect" title="Ulcers">ulcers</a> on the fingertips; skin and mucosal <a href="/wiki/Telangiectasis" class="mw-redirect" title="Telangiectasis">telangiectasis</a>; <a href="/wiki/Palpitations" title="Palpitations">palpitations</a>, irregular heart rate and <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">fainting</a> due to <a href="/wiki/Electrical_conduction_system_of_the_heart" class="mw-redirect" title="Electrical conduction system of the heart">conduction</a> abnormalities, <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>, and <a href="/wiki/Congestive_heart_failure" class="mw-redirect" title="Congestive heart failure">congestive heart failure</a></li> <li>Digestive: <a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux disease</a>, bloating, <a href="/wiki/Dyspepsia" class="mw-redirect" title="Dyspepsia">indigestion</a>, loss of appetite, <a href="/wiki/Diarrhoea" class="mw-redirect" title="Diarrhoea">diarrhoea</a> alternating with <a href="/wiki/Constipation" title="Constipation">constipation</a>, <a href="/wiki/Sicca_syndrome" class="mw-redirect" title="Sicca syndrome">sicca syndrome</a> and its complications, loosening of teeth, and hoarseness (due to acid reflux).</li> <li>Pulmonary: progressive worsening of shortness of breath, chest pain (due to <a href="/wiki/Pulmonary_artery_hypertension" class="mw-redirect" title="Pulmonary artery hypertension">pulmonary artery hypertension</a>) and dry, persistent cough due to <a href="/wiki/Interstitial_lung_disease" title="Interstitial lung disease">interstitial lung disease</a></li> <li>Musculoskeletal: <a href="/wiki/Arthralgia" title="Arthralgia">joint</a>, <a href="/wiki/Myalgia" title="Myalgia">muscle aches</a>, loss of joint range of motion, <a href="/wiki/Carpal_tunnel_syndrome" title="Carpal tunnel syndrome">carpal tunnel syndrome</a>, and <a href="/wiki/Asthenia" class="mw-redirect" title="Asthenia">muscle weakness</a></li> <li>Genitourinary: <a href="/wiki/Erectile_dysfunction" title="Erectile dysfunction">erectile dysfunction</a>, <a href="/wiki/Dyspareunia" title="Dyspareunia">dyspareunia</a>, kidney problems, or <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a></li> <li>Other: facial pain due to <a href="/wiki/Trigeminal_neuralgia" title="Trigeminal neuralgia">trigeminal neuralgia</a>, hand <a href="/wiki/Paresthesias" class="mw-redirect" title="Paresthesias">paresthesias</a>, headache, <a href="/wiki/Stroke" title="Stroke">stroke</a>, fatigue, <a href="/wiki/Calcinosis" title="Calcinosis">calcinosis</a>, and weight loss</li></ul> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=2" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Scleroderma is caused by genetic and environmental factors.<sup id="cite_ref-Bar2012_4-2" class="reference"><a href="#cite_note-Bar2012-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gre2013_5-2" class="reference"><a href="#cite_note-Gre2013-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-path12_16-0" class="reference"><a href="#cite_note-path12-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-env13_17-0" class="reference"><a href="#cite_note-env13-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Mutations in <a href="/wiki/Human_leukocyte_antigen" title="Human leukocyte antigen">HLA</a> genes seem to play a crucial role in the <a href="/wiki/Pathogenesis" title="Pathogenesis">pathogenesis</a> of some cases; likewise <a href="/wiki/Silica" class="mw-redirect" title="Silica">silica</a>, <a href="/wiki/Aromatic_hydrocarbon" class="mw-redirect" title="Aromatic hydrocarbon">aromatic</a> and <a href="/wiki/Chlorinated_hydrocarbon" class="mw-redirect" title="Chlorinated hydrocarbon">chlorinated</a> solvents, <a href="/wiki/Ketones" class="mw-redirect" title="Ketones">ketones</a>, <a href="/wiki/Trichloroethylene" title="Trichloroethylene">trichloroethylene</a>, <a href="/wiki/Welding" title="Welding">welding</a> fumes, and <a href="/wiki/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.<sup id="cite_ref-Bar2012_4-3" class="reference"><a href="#cite_note-Bar2012-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gre2013_5-3" class="reference"><a href="#cite_note-Gre2013-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-path12_16-1" class="reference"><a href="#cite_note-path12-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-env13_17-1" class="reference"><a href="#cite_note-env13-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=3" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Scleroderma is characterised by increased <a href="/wiki/Biosynthesis" title="Biosynthesis">synthesis</a> of <a href="/wiki/Collagen" title="Collagen">collagen</a> (leading to the <a href="/wiki/Sclerosis_(medicine)" title="Sclerosis (medicine)">sclerosis</a>), damage to small blood vessels, activation of <a href="/wiki/T_lymphocytes" class="mw-redirect" title="T lymphocytes">T lymphocytes</a>, and production of altered <a href="/wiki/Connective_tissue" title="Connective tissue">connective tissue</a>.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Its proposed pathogenesis is the following:<sup id="cite_ref-path11_20-0" class="reference"><a href="#cite_note-path11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <ul><li>It begins with an inciting event at the level of the <a href="/wiki/Vasculature" class="mw-redirect" title="Vasculature">vasculature</a>, probably the <a href="/wiki/Endothelium" title="Endothelium">endothelium</a>. The inciting event is yet to be elucidated, but may be a viral agent, <a href="/wiki/Oxidative_stress" title="Oxidative stress">oxidative stress</a>, or autoimmune. <a href="/wiki/Endothelial_cell" class="mw-redirect" title="Endothelial cell">Endothelial cell</a> damage and <a href="/wiki/Apoptosis" title="Apoptosis">apoptosis</a> ensue, leading to the vascular leakiness that manifests in early clinical stages as tissue <a href="/wiki/Oedema" class="mw-redirect" title="Oedema">oedema</a>. At this stage, it is predominantly a <a href="/wiki/Th1_cell" class="mw-redirect" title="Th1 cell">Th1</a>- and <a href="/wiki/Th17" class="mw-redirect" title="Th17">Th17</a>-mediated disease.</li> <li>After this, the vasculature is further compromised by impaired <a href="/wiki/Angiogenesis" title="Angiogenesis">angiogenesis</a> and impaired <a href="/wiki/Vasculogenesis" title="Vasculogenesis">vasculogenesis</a> (fewer endothelial progenitor cells), likely related to the presence of antiendothelinal cell antibodies (AECA). Despite this impaired <a href="/wiki/Angiogenesis" title="Angiogenesis">angiogenesis</a>, elevated levels of pro-angiogenic growth factors such as <a href="/wiki/Platelet_derived_growth_factor" class="mw-redirect" title="Platelet derived growth factor">PDGF</a> and <a href="/wiki/Vascular_endothelial_growth_factor" title="Vascular endothelial growth factor">VEGF</a> is often seen in persons with the condition. The balance of <a href="/wiki/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="/wiki/Ischaemia" class="mw-redirect" title="Ischaemia">ischaemia</a>-<a href="/wiki/Reperfusion_injury" title="Reperfusion injury">reperfusion injury</a> and the generation of <a href="/wiki/Reactive_oxygen_species" title="Reactive oxygen species">reactive oxygen species</a>. These later stages are characterised by <a href="/wiki/Th2" class="mw-redirect" title="Th2">Th2</a> polarity.</li> <li>The damaged endothelium upregulates <a href="/wiki/Adhesion_molecules" class="mw-redirect" title="Adhesion molecules">adhesion molecules</a> and <a href="/wiki/Chemokine" title="Chemokine">chemokines</a> to attract <a href="/wiki/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="/wiki/Antigens" class="mw-redirect" title="Antigens">antigens</a>, which includes <a href="/wiki/Topoisomerase_I" class="mw-redirect" title="Topoisomerase I">topoisomerase I</a>. <a href="/wiki/B_cells" class="mw-redirect" title="B cells">B cells</a> mature into <a href="/wiki/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="/wiki/Fibrosis" title="Fibrosis">fibrosis</a>. <a href="/wiki/Topoisomerase_1" class="mw-redirect" title="Topoisomerase 1">Anti–topoisomerase 1</a> <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a>, in turn, stimulate <a href="/wiki/Type_I_interferon" class="mw-redirect" title="Type I interferon">type I interferon</a> production.</li> <li><a href="/wiki/Fibroblast" title="Fibroblast">Fibroblasts</a> are recruited and activated by multiple <a href="/wiki/Cytokine" title="Cytokine">cytokines</a> and growth factors to generate <a href="/wiki/Myofibroblasts" class="mw-redirect" title="Myofibroblasts">myofibroblasts</a>. Dysregulated <a href="/wiki/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="/wiki/Interleukin_6" title="Interleukin 6">IL-6</a> and TGF-β produced by the B cells decrease collagen degradation and increase <a href="/wiki/Extracellular_matrix" title="Extracellular matrix">extracellular matrix</a> production. <a href="/wiki/Endothelin" title="Endothelin">Endothelin signalling</a> is implicated in the pathophysiology of fibrosis.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup></li></ul> <p><a href="/wiki/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.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=4" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>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="/wiki/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.<sup id="cite_ref-WMSR_27-0" class="reference"><a href="#cite_note-WMSR-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>Laboratory testing can show <a href="/wiki/Anti-topoisomerase_antibodies" title="Anti-topoisomerase antibodies">antitopoisomerase antibodies</a>, like <a href="/wiki/Anti-scl70" class="mw-redirect" title="Anti-scl70">anti-scl70</a> (causing a diffuse systemic form), or <a href="/wiki/Anti-centromere_antibodies" 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.<sup id="cite_ref-MSR_28-0" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Antidouble-stranded DNA autoantibodies are likely to be present in serum.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (October 2020)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Differential">Differential</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=5" title="Edit section: Differential"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diseases that are often in the differential include:<sup id="cite_ref-DMSR_29-0" class="reference"><a href="#cite_note-DMSR-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Eosinophilia" title="Eosinophilia">Eosinophilia</a> is a condition in which too many <a href="/wiki/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="/wiki/Eosinophilia-myalgia_syndrome" class="mw-redirect" title="Eosinophilia-myalgia syndrome">Eosinophilia-myalgia syndrome</a> is a form of eosinophilia caused by <a href="/wiki/L-tryptophan" class="mw-redirect" title="L-tryptophan">L-tryptophan</a> supplements.</li> <li><a href="/wiki/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="/wiki/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="/wiki/Mycosis_fungoides" title="Mycosis fungoides">Mycosis fungoides</a> is a type of <a href="/wiki/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="/wiki/Nephrogenic_systemic_fibrosis" title="Nephrogenic systemic fibrosis">Nephrogenic systemic fibrosis</a> is a condition usually caused by <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a> that results in fibrosis (thickening) of the tissues.</li> <li><a href="/wiki/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="/wiki/Primary_pulmonary_hypertension" class="mw-redirect" title="Primary pulmonary hypertension">Primary pulmonary hypertension</a></li> <li><a href="/wiki/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><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=6" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>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:<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Localised_scleroderma" class="mw-redirect" title="Localised scleroderma">Localised scleroderma</a> <ul><li><a href="/wiki/Localised_morphea" class="mw-redirect" title="Localised morphea">Localised morphea</a></li> <li><a href="/wiki/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="/wiki/Generalised_morphea" class="mw-redirect" title="Generalised morphea">Generalised morphea</a></li> <li><a href="/wiki/Atrophoderma_of_Pasini_and_Pierini" class="mw-redirect" title="Atrophoderma of Pasini and Pierini">Atrophoderma of Pasini and Pierini</a></li> <li><a href="/wiki/Pansclerotic_morphea" class="mw-redirect" title="Pansclerotic morphea">Pansclerotic morphea</a></li> <li><a href="/wiki/Morphea_profunda" class="mw-redirect" title="Morphea profunda">Morphea profunda</a></li> <li><a href="/wiki/Linear_scleroderma" class="mw-redirect" title="Linear scleroderma">Linear scleroderma</a></li></ul></li> <li><a href="/wiki/Systemic_scleroderma" title="Systemic scleroderma">Systemic scleroderma</a> <ul><li><a href="/wiki/CREST_syndrome" title="CREST syndrome">CREST syndrome</a></li> <li><a href="/wiki/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><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=7" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>No cure for scleroderma is known, although relief of symptoms is often achieved; these include treatment of:<sup id="cite_ref-MM_13-1" class="reference"><a href="#cite_note-MM-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-sem_31-0" class="reference"><a href="#cite_note-sem-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Raynaud%27s_phenomenon" class="mw-redirect" title="Raynaud's phenomenon">Raynaud's phenomenon</a> with vasodilators such as <a href="/wiki/Calcium_channel_blockers" class="mw-redirect" title="Calcium channel blockers">calcium channel blockers</a>, <a href="/wiki/Alpha_blocker" title="Alpha blocker">alpha blockers</a>, <a href="/wiki/Serotonin_receptor_antagonist" title="Serotonin receptor antagonist">serotonin receptor antagonists</a>, <a href="/wiki/Angiotensin_II_receptor" title="Angiotensin II receptor">angiotensin II receptor</a> inhibitors, <a href="/wiki/Statins" class="mw-redirect" title="Statins">statins</a>, local nitrates or <a href="/wiki/Iloprost" title="Iloprost">iloprost</a></li> <li>Digital ulcers with <a href="/wiki/Phosphodiesterase_5" class="mw-redirect" title="Phosphodiesterase 5">phosphodiesterase 5</a> inhibitors (e.g., <a href="/wiki/Sildenafil" title="Sildenafil">sildenafil</a>) or <a href="/wiki/Iloprost" title="Iloprost">iloprost</a></li> <li>Prevention of new digital ulcers with <a href="/wiki/Bosentan" title="Bosentan">bosentan</a></li> <li>Malnutrition, secondary to intestinal flora overgrowth with <a href="/wiki/Tetracycline_antibiotic" class="mw-redirect" title="Tetracycline antibiotic">tetracycline antibiotics</a> such as <a href="/wiki/Tetracycline" title="Tetracycline">tetracycline</a></li> <li><a href="/wiki/Interstitial_lung_disease" title="Interstitial lung disease">Interstitial lung disease</a> with <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>, <a href="/wiki/Azathioprine" title="Azathioprine">azathioprine</a> with or without corticosteroids</li> <li><a href="/wiki/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="/wiki/Angiotensin_converting_enzyme_inhibitor" class="mw-redirect" title="Angiotensin converting enzyme inhibitor">angiotensin converting enzyme inhibitors</a> and <a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">angiotensin II receptor antagonists</a></li></ul> <p>Systemic <a href="/wiki/Disease-modifying_treatment" title="Disease-modifying treatment">disease-modifying treatment</a> with immunosuppressants is often used.<sup id="cite_ref-path12_16-2" class="reference"><a href="#cite_note-path12-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-clin13_32-0" class="reference"><a href="#cite_note-clin13-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-mayo_33-0" class="reference"><a href="#cite_note-mayo-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pol_34-0" class="reference"><a href="#cite_note-pol-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-arch_35-0" class="reference"><a href="#cite_note-arch-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-exp_36-0" class="reference"><a href="#cite_note-exp-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> Immunosuppressants used in its treatment include <a href="/wiki/Azathioprine" title="Azathioprine">azathioprine</a>, <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>, <a href="/wiki/Mycophenolate" class="mw-redirect" title="Mycophenolate">mycophenolate</a>, intravenous <a href="/wiki/Immunoglobulin" class="mw-redirect" title="Immunoglobulin">immunoglobulin</a>, <a href="/wiki/Rituximab" title="Rituximab">rituximab</a>, <a href="/wiki/Sirolimus" title="Sirolimus">sirolimus</a>, <a href="/wiki/Alefacept" title="Alefacept">alefacept</a>, and the tyrosine kinase inhibitors, <a href="/wiki/Imatinib" title="Imatinib">imatinib</a>, <a href="/wiki/Nilotinib" title="Nilotinib">nilotinib</a>, and <a href="/wiki/Dasatinib" title="Dasatinib">dasatinib</a>.<sup id="cite_ref-path12_16-3" class="reference"><a href="#cite_note-path12-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-sem_31-1" class="reference"><a href="#cite_note-sem-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-clin13_32-1" class="reference"><a href="#cite_note-clin13-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-mayo_33-1" class="reference"><a href="#cite_note-mayo-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pol_34-1" class="reference"><a href="#cite_note-pol-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-arch_35-1" class="reference"><a href="#cite_note-arch-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-exp_36-1" class="reference"><a href="#cite_note-exp-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p><p>Experimental therapies under investigation include endothelin receptor antagonists, tyrosine kinase inhibitors, beta-glycan peptides, <a href="/wiki/Halofuginone" title="Halofuginone">halofuginone</a>, <a href="/wiki/Basiliximab" title="Basiliximab">basiliximab</a>, <a href="/wiki/Alemtuzumab" title="Alemtuzumab">alemtuzumab</a>, <a href="/wiki/Abatacept" title="Abatacept">abatacept</a>, and <a href="/wiki/Haematopoietic_stem_cell_transplantation" class="mw-redirect" title="Haematopoietic stem cell transplantation">haematopoietic stem cell transplantation</a>.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable" style="width:100%; font-size:88%"> <tbody><tr> <th colspan="5">Immunomodulatory agents in the treatment of scleroderma </th></tr> <tr> <th><a href="/wiki/International_Nonproprietary_Name" class="mw-redirect" title="International Nonproprietary Name">INN</a></th> <th>Mechanism of action<sup id="cite_ref-AMH_40-0" class="reference"><a href="#cite_note-AMH-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-GG_41-0" class="reference"><a href="#cite_note-GG-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup></th> <th>Route of administration<sup id="cite_ref-AMH_40-1" class="reference"><a href="#cite_note-AMH-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup></th> <th>Pregnancy category<sup id="cite_ref-AMH_40-2" class="reference"><a href="#cite_note-AMH-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-MSRD_42-0" class="reference"><a href="#cite_note-MSRD-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup></th> <th>Major toxicities<sup id="cite_ref-AMH_40-3" class="reference"><a href="#cite_note-AMH-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </th></tr> <tr> <td><a href="/wiki/Alefacept" title="Alefacept">Alefacept</a></td> <td>Monoclonal antibody to inhibit T lymphocyte activation by binding to CD2 portion of <a href="/wiki/Human_leukocyte_antigen" title="Human leukocyte antigen">human leukocyte function antigen-3</a>.</td> <td>IM</td> <td>B (US)</td> <td>Malignancies, injection site reactions, blood clots, <a href="/wiki/Lymphopenia" class="mw-redirect" title="Lymphopenia">lymphopenia</a>, hepatotoxicity and infections. </td></tr> <tr> <td><a href="/wiki/Azathioprine" title="Azathioprine">Azathioprine</a></td> <td>Purine analogue that inhibits lymphocyte proliferation via conversion to <a href="/wiki/Mercaptopurine" title="Mercaptopurine">mercaptopurine</a></td> <td>PO, IV</td> <td>D (Au)</td> <td><a href="/wiki/Myelosuppression" class="mw-redirect" title="Myelosuppression">Myelosuppression</a> and <i>rarely</i> malignancy, hepatitis, infection, <a href="/wiki/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="/wiki/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>PO, IV</td> <td>D (Au)</td> <td>Vomiting, myelosuppression, <a href="/wiki/Haemorrhagic_cystitis" class="mw-redirect" title="Haemorrhagic cystitis">haemorrhagic cystitis</a> and <i>rarely</i> heart failure, pulmonary fibrosis, <a href="/wiki/Hepatic_sinusoidal_obstruction_syndrome" class="mw-redirect" title="Hepatic sinusoidal obstruction syndrome">hepatic sinusoidal obstruction syndrome</a>, malignancy and <a href="/wiki/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="/wiki/Dasatinib" title="Dasatinib">Dasatinib</a></td> <td><a href="/wiki/Tyrosine_kinase" title="Tyrosine kinase">Tyrosine kinase</a> inhibitor against various proangiogenic growth factors (including PDGF and VEGF).</td> <td>PO</td> <td>D (Au)</td> <td>Fluid retention, myelosuppression, haemorrhage, infections, pulmonary hypertension, electrolyte anomalies and <i>uncommonly</i> hepatotoxicity, heart dysfunction/failure, myocardial infarction, QT interval prolongation, renal failure and hypersensitivity. </td></tr> <tr> <td><a href="/wiki/Imatinib" title="Imatinib">Imatinib</a></td> <td>As above</td> <td>PO</td> <td>D (Au)</td> <td>As above and <i>rarely:</i> GI perforation, avascular necrosis and <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a> </td></tr> <tr> <td><a href="/wiki/Immunoglobulin" class="mw-redirect" title="Immunoglobulin">Immunoglobulin</a></td> <td>Immunoglobulin, modulates the immune system.</td> <td>IV</td> <td>N/A</td> <td>Varies </td></tr> <tr> <td><a href="/wiki/Methotrexate" title="Methotrexate">Methotrexate</a></td> <td>Antifolate; inhibits <a href="/wiki/Dihydrofolate_reductase" title="Dihydrofolate reductase">dihydrofolate reductase</a>.</td> <td>PO, IV, IM, SC, IT</td> <td>D (Au)</td> <td>Myeosuppression, pulmonary toxicity, hepatotoxicity, neurotoxicity and <i>rarely</i> kidney failure, hypersensitivity reactions, skin and bone necrosis, and osteoporosis </td></tr> <tr> <td><a href="/wiki/Mycophenolate" class="mw-redirect" title="Mycophenolate">Mycophenolate</a></td> <td><a href="/wiki/Inosine_monophosphate_dehydrogenase" class="mw-redirect" title="Inosine monophosphate dehydrogenase">Inosine monophosphate dehydrogenase</a> inhibitor, leading to reduced purine biosynthesis in lymphocytes.</td> <td>PO, IV</td> <td>D (Au)</td> <td>Myelosuppression, blood clots, <i>less commonly</i> GI perforation/haemorrhage and <i>rarely</i> <a href="/wiki/Pancreatitis" title="Pancreatitis">pancreatitis</a>, <a href="/wiki/Hepatitis" title="Hepatitis">hepatitis</a>, <a href="/wiki/Aplastic_anaemia" class="mw-redirect" title="Aplastic anaemia">aplastic anaemia</a> and <a href="/wiki/Pure_red_cell_aplasia" title="Pure red cell aplasia">pure red cell aplasia</a>. </td></tr> <tr> <td><a href="/wiki/Nilotinib" title="Nilotinib">Nilotinib</a></td> <td>As per dasatinib</td> <td>PO</td> <td>D (Au)</td> <td>As per imatinib </td></tr> <tr> <td><a href="/wiki/Rituximab" title="Rituximab">Rituximab</a></td> <td>Monoclonal antibody against <a href="/wiki/CD20" title="CD20">CD20</a>, which is expressed on B lymphocytes</td> <td>IV</td> <td>C (Au)</td> <td>Infusion-related reactions, infection, <a href="/wiki/Neutropenia" title="Neutropenia">neutropenia</a>, reduced immunoglobulin levels, arrhythmias, <i>less commonly</i> anaemia, thrombocytopenia, angina, myocardial infarction, heart failure, and <i>rarely</i> <a href="/wiki/Haemolytic_anaemia" class="mw-redirect" title="Haemolytic anaemia">haemolytic anaemia</a>, <a href="/wiki/Aplastic_anaemia" class="mw-redirect" title="Aplastic anaemia">aplastic anaemia</a>, serum sickness, severe skin conditions, pulmonary infiltrates, <a href="/wiki/Pneumonitis" title="Pneumonitis">pneumonitis</a>, cranial neuropathy (vision or hearing loss) and <a href="/wiki/Progressive_multifocal_leucoencephalopathy" class="mw-redirect" title="Progressive multifocal leucoencephalopathy">progressive multifocal leucoencephalopathy</a>. </td></tr> <tr> <td><a href="/wiki/Sirolimus" title="Sirolimus">Sirolimus</a></td> <td><a href="/wiki/Mammalian_target_of_rapamycin" class="mw-redirect" title="Mammalian target of rapamycin">mTOR</a> inhibitor, thereby reducing cytokine-induced lymphocyte proliferation.</td> <td>PO</td> <td>C (Au)</td> <td><a href="/wiki/Neutropenia" title="Neutropenia">Neutropenia</a>, <a href="/wiki/Hypokalaemia" class="mw-redirect" title="Hypokalaemia">hypokalaemia</a>, interstitial lung disease, <a href="/wiki/Pericardial_effusion" title="Pericardial effusion">pericardial effusion</a>, <a href="/wiki/Pleural_effusion" title="Pleural effusion">pleural effusion</a>, <i>less commonly</i> pulmonary haemorrhage, nephrotic syndrome, and <i>rarely</i> hepatotoxicity and <a href="/wiki/Lymphoedema" class="mw-redirect" title="Lymphoedema">lymphoedema</a>. </td></tr> <tr> <td colspan="5">PO = Oral. IV = Intravenous. IM = Intramuscular. SC = Subcutaneous. IT = Intrathecal.<br /> <p>The preferred pregnancy category, above, is Australian, if available. If unavailable, an American one is substituted. </p> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=8" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As of 2012<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Scleroderma&action=edit">[update]</a></sup>, the five-year survival rate for systemic scleroderma was about 85%, whereas the 10-year survival rate was just under 70%.<sup id="cite_ref-germ_43-0" class="reference"><a href="#cite_note-germ-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> 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="/wiki/Pulmonary_hypertension" title="Pulmonary hypertension">pulmonary hypertension</a>, <a href="/wiki/Pulmonary_fibrosis" title="Pulmonary fibrosis">pulmonary fibrosis</a>, and scleroderma renal crisis.<sup id="cite_ref-MSR_28-1" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> People with scleroderma are also at a heightened risk for developing osteoporosis and for contracting cancer (especially liver, lung, haematologic, and bladder cancers).<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Scleroderma is also associated with an increased risk of cardiovascular disease.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>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).<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=9" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Scleroderma most commonly first presents between the ages of 20 and 50 years, although any age group can be affected.<sup id="cite_ref-MM_13-2" class="reference"><a href="#cite_note-MM-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-MSR_28-2" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Women are four to nine times more likely to develop scleroderma than men.<sup id="cite_ref-MSR_28-3" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>This disease is found worldwide.<sup id="cite_ref-MSR_28-4" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> In the United States, prevalence is estimated at 240 per million and the annual incidence of scleroderma is 19 per million people.<sup id="cite_ref-MSR_28-5" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Likewise in the United States, it is slightly more common in <a href="/wiki/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.<sup id="cite_ref-MSR_28-6" class="reference"><a href="#cite_note-MSR-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> In <a href="/wiki/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.<sup id="cite_ref-germ_43-1" class="reference"><a href="#cite_note-germ-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> In <a href="/wiki/South_Australia" title="South Australia">South Australia</a>, the annual incidence is 23 per million people, and the prevalence 233 per million people.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pregnancy">Pregnancy</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=10" title="Edit section: Pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Scleroderma in pregnancy is a complex situation; it increases the risk to both mother and child.<sup id="cite_ref-preg_48-0" class="reference"><a href="#cite_note-preg-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Overall, scleroderma is associated with reduced fetal weight for gestational age.<sup id="cite_ref-preg_48-1" class="reference"><a href="#cite_note-preg-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> The treatment for scleroderma often includes known teratogens such as cyclophosphamide, methotrexate, <a href="/wiki/Mycophenolate" class="mw-redirect" title="Mycophenolate">mycophenolate</a>, etc., so careful avoidance of such drugs during pregnancy is advised.<sup id="cite_ref-preg_48-2" class="reference"><a href="#cite_note-preg-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> In these cases <a href="/wiki/Hydroxychloroquine" title="Hydroxychloroquine">hydroxychloroquine</a> and low-dose <a href="/wiki/Corticosteroid" title="Corticosteroid">corticosteroids</a> might be used for disease control.<sup id="cite_ref-preg_48-3" class="reference"><a href="#cite_note-preg-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=11" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Congenital_fascial_dystrophy" class="mw-redirect" title="Congenital fascial dystrophy">Congenital fascial dystrophy</a></li> <li><a href="/wiki/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><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=12" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-NORD2007-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-NORD2007_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-NORD2007_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-NORD2007_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-NORD2007_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-NORD2007_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-NORD2007_1-5"><sup><i><b>f</b></i></sup></a> <a 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class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Scleroderma&action=edit&section=13" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="http://niams.nih.gov/Health_Info/Scleroderma/default.asp">Handout on Health: Scleroderma</a> – US National Institute of Arthritis and Musculoskeletal and Skin Diseases</li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output 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dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q958797" class="extiw" title="d:Q958797">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/L94.0">L94.0</a>–<a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/L94.1">L94.1</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/M34">M34</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=701.0">701.0</a> <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=710.1">710.1</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/201441006">201441006</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000429.htm">000429</a></li><li><b><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a></b>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=801">801</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_skin_and_appendages_by_morphology" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Diseases_of_the_skin_and_appendages_by_morphology" title="Template:Diseases of the skin and appendages by morphology"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Diseases_of_the_skin_and_appendages_by_morphology" title="Template talk:Diseases of the skin and appendages by morphology"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Diseases_of_the_skin_and_appendages_by_morphology" title="Special:EditPage/Template:Diseases of the skin and appendages by morphology"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_skin_and_appendages_by_morphology" 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="/wiki/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"> <ul><li><a href="/wiki/Wart" title="Wart">Wart</a></li> <li><a href="/wiki/Callus" title="Callus">Callus</a></li> <li><a href="/wiki/Seborrheic_keratosis" title="Seborrheic keratosis">Seborrheic keratosis</a></li> <li><a href="/wiki/Skin_tag" title="Skin tag">Acrochordon</a></li> <li><a href="/wiki/Molluscum_contagiosum" title="Molluscum contagiosum">Molluscum contagiosum</a></li> <li><a href="/wiki/Actinic_keratosis" title="Actinic keratosis">Actinic keratosis</a></li> <li><a href="/wiki/Squamous-cell_carcinoma" title="Squamous-cell carcinoma">Squamous-cell carcinoma</a></li> <li><a href="/wiki/Basal-cell_carcinoma" title="Basal-cell carcinoma">Basal-cell carcinoma</a></li> <li><a href="/wiki/Merkel-cell_carcinoma" title="Merkel-cell carcinoma">Merkel-cell carcinoma</a></li> <li><a href="/wiki/Nevus_sebaceous" title="Nevus sebaceous">Nevus sebaceous</a></li> <li><a href="/wiki/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="/wiki/Freckle" title="Freckle">Freckles</a></li> <li><a href="/wiki/Lentigo" title="Lentigo">Lentigo</a></li> <li><a href="/wiki/Melasma" title="Melasma">Melasma</a></li> <li><a href="/wiki/Nevus" title="Nevus">Nevus</a></li> <li><a href="/wiki/Melanoma" title="Melanoma">Melanoma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dermis" title="Dermis">Dermal</a> and<br />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="/wiki/Epidermoid_cyst" title="Epidermoid cyst">Epidermal inclusion cyst</a></li> <li><a href="/wiki/Hemangioma" title="Hemangioma">Hemangioma</a></li> <li><a href="/wiki/Benign_fibrous_histiocytoma" class="mw-redirect" title="Benign fibrous histiocytoma">Dermatofibroma (benign fibrous histiocytoma)</a></li> <li><a href="/wiki/Keloid" title="Keloid">Keloid</a></li> <li><a href="/wiki/Lipoma" title="Lipoma">Lipoma</a></li> <li><a href="/wiki/Neurofibroma" title="Neurofibroma">Neurofibroma</a></li> <li><a href="/wiki/Xanthoma" title="Xanthoma">Xanthoma</a></li> <li><a href="/wiki/Kaposi%27s_sarcoma" title="Kaposi's sarcoma">Kaposi's sarcoma</a></li> <li><a href="/wiki/Infantile_digital_fibromatosis" title="Infantile digital fibromatosis">Infantile digital fibromatosis</a></li> <li><a href="/wiki/Granular_cell_tumor" title="Granular cell tumor">Granular cell tumor</a></li> <li><a href="/wiki/Leiomyoma" title="Leiomyoma">Leiomyoma</a></li> <li><a href="/wiki/Lymphangioma_circumscriptum" title="Lymphangioma circumscriptum">Lymphangioma circumscriptum</a></li> <li><a href="/wiki/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="/wiki/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<br /> epidermal<br /> 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="/wiki/Contact_dermatitis" title="Contact dermatitis">Contact dermatitis</a></li> <li><a href="/wiki/Atopic_dermatitis" title="Atopic dermatitis">Atopic dermatitis</a></li> <li><a href="/wiki/Seborrhoeic_dermatitis" title="Seborrhoeic dermatitis">Seborrheic dermatitis</a></li> <li><a href="/wiki/Stasis_dermatitis" title="Stasis dermatitis">Stasis dermatitis</a></li> <li><a href="/wiki/Lichen_simplex_chronicus" title="Lichen simplex chronicus">Lichen simplex chronicus</a></li> <li><a href="/wiki/Darier%27s_disease" title="Darier's disease">Darier's disease</a></li> <li><a href="/wiki/Glucagonoma_syndrome" class="mw-redirect" title="Glucagonoma syndrome">Glucagonoma syndrome</a></li> <li><a href="/wiki/Langerhans_cell_histiocytosis" title="Langerhans cell histiocytosis">Langerhans cell histiocytosis</a></li> <li><a href="/wiki/Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosus</a></li> <li><a href="/wiki/Pemphigus" title="Pemphigus">Pemphigus foliaceus</a></li> <li><a href="/wiki/Wiskott%E2%80%93Aldrich_syndrome" title="Wiskott–Aldrich syndrome">Wiskott–Aldrich syndrome</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/Psoriasis" title="Psoriasis">Psoriasis</a></li> <li>Tinea (<a href="/wiki/Tinea_corporis" title="Tinea corporis">Corporis</a></li> <li><a href="/wiki/Tinea_cruris" title="Tinea cruris">Cruris</a></li> <li><a href="/wiki/Athlete%27s_foot" title="Athlete's foot">Pedis</a></li> <li><a href="/wiki/Tinea_manuum" title="Tinea manuum">Manuum</a></li> <li><a href="/wiki/Tinea_faciei" title="Tinea faciei">Faciei</a>)</li> <li><a href="/wiki/Pityriasis_rosea" title="Pityriasis rosea">Pityriasis rosea</a></li> <li><a href="/wiki/Syphilis" title="Syphilis">Secondary syphilis</a></li> <li><a href="/wiki/Mycosis_fungoides" title="Mycosis fungoides">Mycosis fungoides</a></li> <li><a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li> <li><a href="/wiki/Pityriasis_rubra_pilaris" title="Pityriasis rubra pilaris">Pityriasis rubra pilaris</a></li> <li><a href="/wiki/Parapsoriasis" title="Parapsoriasis">Parapsoriasis</a></li> <li><a href="/wiki/Ichthyosis" title="Ichthyosis">Ichthyosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/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="/wiki/Herpes" title="Herpes">Herpes simplex</a></li> <li><a href="/wiki/Herpes_zoster" class="mw-redirect" title="Herpes zoster">Herpes zoster</a></li> <li><a href="/wiki/Chickenpox" title="Chickenpox">Varicella</a></li> <li><a href="/wiki/Impetigo" title="Impetigo">Bullous impetigo</a></li> <li><a href="/wiki/Contact_dermatitis" title="Contact dermatitis">Acute contact dermatitis</a></li> <li><a href="/wiki/Pemphigus_vulgaris" title="Pemphigus vulgaris">Pemphigus vulgaris</a></li> <li><a href="/wiki/Bullous_pemphigoid" title="Bullous pemphigoid">Bullous pemphigoid</a></li> <li><a href="/wiki/Dermatitis_herpetiformis" title="Dermatitis herpetiformis">Dermatitis herpetiformis</a></li> <li><a href="/wiki/Porphyria_cutanea_tarda" title="Porphyria cutanea tarda">Porphyria cutanea tarda</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/Scabies" title="Scabies">Scabies</a></li> <li><a href="/wiki/Insect_bites_and_stings" class="mw-redirect" title="Insect bites and stings">Insect bite reactions</a></li> <li><a href="/wiki/Lichen_planus" title="Lichen planus">Lichen planus</a></li> <li><a href="/wiki/Miliaria" title="Miliaria">Miliaria</a></li> <li><a href="/wiki/Keratosis_pilaris" title="Keratosis pilaris">Keratosis pilaris</a></li> <li><a href="/wiki/Lichen_spinulosus" title="Lichen spinulosus">Lichen spinulosus</a></li> <li><a href="/wiki/Transient_acantholytic_dermatosis" title="Transient acantholytic dermatosis">Transient acantholytic dermatosis</a></li> <li><a href="/wiki/Lichen_nitidus" title="Lichen nitidus">Lichen nitidus</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/Acne_vulgaris" class="mw-redirect" title="Acne vulgaris">Acne vulgaris</a></li> <li><a href="/wiki/Rosacea" title="Rosacea">Rosacea</a></li> <li><a href="/wiki/Folliculitis" title="Folliculitis">Folliculitis</a></li> <li><a href="/wiki/Impetigo" title="Impetigo">Impetigo</a></li> <li><a href="/wiki/Candidiasis" title="Candidiasis">Candidiasis</a></li> <li><a href="/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae">Gonococcemia</a></li> <li><a href="/wiki/Dermatophyte" title="Dermatophyte">Dermatophyte</a></li> <li><a href="/wiki/Coccidioidomycosis" title="Coccidioidomycosis">Coccidioidomycosis</a></li> <li><a href="/wiki/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="/wiki/Tinea_versicolor" title="Tinea versicolor">Tinea versicolor</a></li> <li><a href="/wiki/Vitiligo" title="Vitiligo">Vitiligo</a></li> <li><a href="/wiki/Pityriasis_alba" title="Pityriasis alba">Pityriasis alba</a></li> <li><a href="/wiki/Postinflammatory_hyperpigmentation" title="Postinflammatory hyperpigmentation">Postinflammatory hyperpigmentation</a></li> <li><a href="/wiki/Tuberous_sclerosis" title="Tuberous sclerosis">Tuberous sclerosis</a></li> <li><a href="/wiki/Idiopathic_guttate_hypomelanosis" title="Idiopathic guttate hypomelanosis">Idiopathic guttate hypomelanosis</a></li> <li><a href="/wiki/Leprosy" title="Leprosy">Leprosy</a></li> <li><a href="/wiki/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<br /> epidermal<br /> 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="Red" 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<br /> <a href="/wiki/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="/wiki/Drug_eruption" title="Drug eruption">Drug eruptions</a></li> <li><a href="/wiki/Exanthem" title="Exanthem">Viral exanthems</a></li> <li><a href="/wiki/Erythema_toxicum_neonatorum" title="Erythema toxicum neonatorum">Toxic erythema</a></li> <li><a href="/wiki/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="/wiki/Cellulitis" title="Cellulitis">Cellulitis</a></li> <li><a href="/wiki/Abscess" title="Abscess">Abscess</a></li> <li><a href="/wiki/Boil" title="Boil">Boil</a></li> <li><a href="/wiki/Erythema_nodosum" title="Erythema nodosum">Erythema nodosum</a></li> <li><a href="/wiki/Carcinoid_syndrome" title="Carcinoid syndrome">Carcinoid syndrome</a></li> <li><a href="/wiki/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="/wiki/Urticaria" class="mw-redirect" title="Urticaria">Urticaria</a></li> <li>Erythema (<a href="/wiki/Erythema_multiforme" title="Erythema multiforme">Multiforme</a></li> <li><a href="/wiki/Erythema_chronicum_migrans" class="mw-redirect" title="Erythema chronicum migrans">Migrans</a></li> <li><a href="/wiki/Erythema_gyratum_repens" title="Erythema gyratum repens">Gyratum repens</a></li> <li><a href="/wiki/Erythema_annulare_centrifugum" title="Erythema annulare centrifugum">Annulare centrifugum</a></li> <li><a href="/wiki/Erythema_ab_igne" title="Erythema ab igne">Ab igne</a>)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonblanchable<br /> 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="/wiki/Thrombocytopenic_purpura" title="Thrombocytopenic purpura">Thrombocytopenic purpura</a></li> <li><a href="/wiki/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="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">Disseminated intravascular coagulation</a></li> <li><a href="/wiki/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 class="mw-selflink selflink">Scleroderma</a>/<a href="/wiki/Morphea" title="Morphea">morphea</a></li> <li><a href="/wiki/Granuloma_annulare" title="Granuloma annulare">Granuloma annulare</a></li> <li><a href="/wiki/Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosis et atrophicus</a></li> <li><a href="/wiki/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<br /> 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="/wiki/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"> <ul><li class="mw-empty-elt"></li></ul> </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="/wiki/Telogen_effluvium" title="Telogen effluvium">Telogen effluvium</a></li> <li><a href="/wiki/Androgenic_alopecia" class="mw-redirect" title="Androgenic alopecia">Androgenic alopecia</a></li> <li><a href="/wiki/Alopecia_areata" title="Alopecia areata">Alopecia areata</a></li> <li><a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li> <li><a href="/wiki/Tinea_capitis" title="Tinea capitis">Tinea capitis</a></li> <li><a href="/wiki/Loose_anagen_syndrome" title="Loose anagen syndrome">Loose anagen syndrome</a></li> <li><a href="/wiki/Lichen_planopilaris" class="mw-redirect" title="Lichen planopilaris">Lichen planopilaris</a></li> <li><a href="/wiki/Folliculitis_decalvans" title="Folliculitis decalvans">Folliculitis decalvans</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/Onychomycosis" title="Onychomycosis">Onychomycosis</a></li> <li><a href="/wiki/Psoriasis" title="Psoriasis">Psoriasis</a></li> <li><a href="/wiki/Paronychia" title="Paronychia">Paronychia</a></li> <li><a href="/wiki/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="/wiki/Mucous_membrane" title="Mucous membrane">Mucous<br /> 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="/wiki/Aphthous_stomatitis" title="Aphthous stomatitis">Aphthous stomatitis</a></li> <li><a href="/wiki/Oral_candidiasis" title="Oral candidiasis">Oral candidiasis</a></li> <li><a href="/wiki/Lichen_planus" title="Lichen planus">Lichen planus</a></li> <li><a href="/wiki/Leukoplakia" title="Leukoplakia">Leukoplakia</a></li> <li><a href="/wiki/Pemphigus" title="Pemphigus">Pemphigus vulgaris</a></li> <li><a href="/wiki/Mucous_membrane_pemphigoid" title="Mucous membrane pemphigoid">Mucous membrane pemphigoid</a></li> <li><a href="/wiki/Cicatricial_pemphigoid" class="mw-redirect" title="Cicatricial pemphigoid">Cicatricial pemphigoid</a></li> <li><a href="/wiki/Herpesviridae" title="Herpesviridae">Herpesvirus</a></li> <li><a href="/wiki/Coxsackievirus" title="Coxsackievirus">Coxsackievirus</a></li> <li><a href="/wiki/Syphilis" title="Syphilis">Syphilis</a></li> <li><a href="/wiki/Histoplasmosis" title="Histoplasmosis">Systemic histoplasmosis</a></li> <li><a href="/wiki/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"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis" 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"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis" title="Template:Cutaneous keratosis, ulcer, atrophy, and necrobiosis"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis" title="Template talk:Cutaneous keratosis, ulcer, atrophy, and necrobiosis"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis" title="Special:EditPage/Template:Cutaneous keratosis, ulcer, atrophy, and necrobiosis"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Cutaneous_keratosis,_ulcer,_atrophy,_and_necrobiosis" 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="/wiki/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="/wiki/Keratoderma" title="Keratoderma">keratoderma</a>: <a href="/wiki/Keratoderma_climactericum" title="Keratoderma climactericum">Keratoderma climactericum</a></li> <li><a href="/wiki/Paraneoplastic_keratoderma" title="Paraneoplastic keratoderma">Paraneoplastic keratoderma</a> <ul><li><a href="/wiki/Paraneoplastic_acrokeratosis" title="Paraneoplastic acrokeratosis">Acrokeratosis paraneoplastica of Bazex</a></li></ul></li> <li><a href="/wiki/Palmoplantar_keratoderma" title="Palmoplantar keratoderma">Aquagenic keratoderma</a></li> <li><a href="/wiki/Drug-induced_keratoderma" title="Drug-induced keratoderma">Drug-induced keratoderma</a></li> <li><i><a href="/wiki/Psoriasis" title="Psoriasis">psoriasis</a></i> <ul><li><a href="/wiki/Keratoderma_blennorrhagicum" title="Keratoderma blennorrhagicum">Keratoderma blennorrhagicum</a></li></ul></li></ul> <ul><li><a href="/wiki/Keratosis" title="Keratosis">keratosis</a>: <a href="/wiki/Seborrheic_keratosis" title="Seborrheic keratosis">Seborrheic keratosis</a> <ul><li><a href="/wiki/Clonal_seborrheic_keratosis" class="mw-redirect" title="Clonal seborrheic keratosis">Clonal seborrheic keratosis</a></li> <li><a href="/wiki/Common_seborrheic_keratosis" class="mw-redirect" title="Common seborrheic keratosis">Common seborrheic keratosis</a></li> <li><a href="/wiki/Irritated_seborrheic_keratosis" class="mw-redirect" title="Irritated seborrheic keratosis">Irritated seborrheic keratosis</a></li> <li><a href="/wiki/Seborrheic_keratosis_with_squamous_atypia" class="mw-redirect" title="Seborrheic keratosis with squamous atypia">Seborrheic keratosis with squamous atypia</a></li> <li><a href="/wiki/Reticulated_seborrheic_keratosis" class="mw-redirect" title="Reticulated seborrheic keratosis">Reticulated seborrheic keratosis</a></li> <li><a href="/wiki/Dermatosis_papulosa_nigra" title="Dermatosis papulosa nigra">Dermatosis papulosa nigra</a></li></ul></li> <li><a href="/wiki/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="/wiki/Hyperkeratosis" title="Hyperkeratosis">hyperkeratosis</a>: <a href="/wiki/Acanthosis_nigricans" title="Acanthosis nigricans">Acanthosis nigricans</a> <ul><li><a href="/wiki/Confluent_and_reticulated_papillomatosis" title="Confluent and reticulated papillomatosis">Confluent and reticulated papillomatosis</a></li></ul></li> <li><a href="/wiki/Callus" title="Callus">Callus</a></li> <li><a href="/wiki/Ichthyosis_acquisita" title="Ichthyosis acquisita">Ichthyosis acquisita</a></li> <li><a href="/wiki/Arsenical_keratosis" title="Arsenical keratosis">Arsenical keratosis</a></li> <li><a href="/wiki/Chronic_scar_keratosis" title="Chronic scar keratosis">Chronic scar keratosis</a></li> <li><a href="/wiki/Hyperkeratosis_lenticularis_perstans" class="mw-redirect" title="Hyperkeratosis lenticularis perstans">Hyperkeratosis lenticularis perstans</a></li> <li><a href="/wiki/Hydrocarbon_keratosis" title="Hydrocarbon keratosis">Hydrocarbon keratosis</a></li> <li><a href="/wiki/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="/wiki/Inverted_follicular_keratosis" class="mw-redirect" title="Inverted follicular keratosis">Inverted follicular keratosis</a></li> <li><a href="/wiki/Lichen_planus" title="Lichen planus">Lichenoid keratosis</a></li> <li><a href="/wiki/Multiple_minute_digitate_hyperkeratosis" title="Multiple minute digitate hyperkeratosis">Multiple minute digitate hyperkeratosis</a></li> <li><a href="/wiki/PUVA_keratosis" title="PUVA keratosis">PUVA keratosis</a></li> <li><a href="/wiki/Reactional_keratosis" title="Reactional keratosis">Reactional keratosis</a></li> <li><a href="/wiki/Stucco_keratosis" class="mw-redirect" title="Stucco keratosis">Stucco keratosis</a></li> <li><a href="/wiki/Thermal_keratosis" title="Thermal keratosis">Thermal keratosis</a></li> <li><a href="/wiki/Wart" title="Wart">Viral keratosis</a></li> <li><a href="/wiki/Warty_dyskeratoma" title="Warty dyskeratoma">Warty dyskeratoma</a></li> <li><a href="/wiki/Waxy_keratosis_of_childhood" title="Waxy keratosis of childhood">Waxy keratosis of childhood</a></li></ul> <ul><li>other hypertrophy: <a href="/wiki/Keloid" title="Keloid">Keloid</a></li> <li><a href="/wiki/Hypertrophic_scar" title="Hypertrophic scar">Hypertrophic scar</a></li> <li><a href="/wiki/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="/wiki/Necrobiosis" title="Necrobiosis">Necrobiosis</a>/<a href="/wiki/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="/wiki/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="/wiki/Granuloma_annulare" title="Granuloma annulare">Granuloma annulare</a> <ul><li><a href="/wiki/Perforating_granuloma_annulare" title="Perforating granuloma annulare">Perforating</a></li> <li><a href="/wiki/Generalized_granuloma_annulare" title="Generalized granuloma annulare">Generalized</a></li> <li><a href="/wiki/Subcutaneous_granuloma_annulare" title="Subcutaneous granuloma annulare">Subcutaneous</a></li> <li><a href="/wiki/Granuloma_annulare_in_HIV_disease" class="mw-redirect" title="Granuloma annulare in HIV disease">Granuloma annulare in HIV disease</a></li> <li><a href="/wiki/Localized_granuloma_annulare" title="Localized granuloma annulare">Localized granuloma annulare</a></li> <li><a href="/wiki/Patch-type_granuloma_annulare" title="Patch-type granuloma annulare">Patch-type granuloma annulare</a></li></ul></li> <li><a href="/wiki/Necrobiosis_lipoidica" title="Necrobiosis lipoidica">Necrobiosis lipoidica</a></li> <li><a href="/wiki/Annular_elastolytic_giant-cell_granuloma" title="Annular elastolytic giant-cell granuloma">Annular elastolytic giant-cell granuloma</a></li> <li><a href="/wiki/Granuloma_multiforme" title="Granuloma multiforme">Granuloma multiforme</a></li> <li><a href="/wiki/Necrobiotic_xanthogranuloma" title="Necrobiotic xanthogranuloma">Necrobiotic xanthogranuloma</a></li> <li><a href="/wiki/Palisaded_neutrophilic_and_granulomatous_dermatitis" title="Palisaded neutrophilic and granulomatous dermatitis">Palisaded neutrophilic and granulomatous dermatitis</a></li> <li><a href="/wiki/Rheumatoid_nodulosis" title="Rheumatoid nodulosis">Rheumatoid nodulosis</a></li> <li><a href="/wiki/Interstitial_granulomatous_dermatitis_with_arthritis" title="Interstitial granulomatous dermatitis with arthritis">Interstitial granulomatous dermatitis</a>/<a href="/wiki/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="/wiki/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="/wiki/Beryllium_granuloma" title="Beryllium granuloma">Beryllium granuloma</a></li> <li><a href="/wiki/Mercury_granuloma" title="Mercury granuloma">Mercury granuloma</a></li> <li><a href="/wiki/Silica_granuloma" title="Silica granuloma">Silica granuloma</a></li> <li><a href="/wiki/Silicone_granuloma" title="Silicone granuloma">Silicone granuloma</a></li> <li><a href="/wiki/Zirconium_granuloma" title="Zirconium granuloma">Zirconium granuloma</a></li> <li><a href="/wiki/Soot_tattoo" title="Soot tattoo">Soot tattoo</a></li> <li><a href="/wiki/Tattoo" title="Tattoo">Tattoo</a></li> <li><a href="/wiki/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><i><a href="/wiki/Eosinophilic_dermatosis" title="Eosinophilic dermatosis">eosinophilic dermatosis</a></i> <ul><li><a href="/wiki/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="/wiki/Dermis" title="Dermis">Dermis</a>/<br />localized <a href="/wiki/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="/wiki/Lupus_erythematosus" title="Lupus erythematosus">Cutaneous lupus<br />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="/wiki/Discoid_lupus_erythematosus" title="Discoid lupus erythematosus">Discoid</a></li> <li><a href="/wiki/Lupus_erythematosus_panniculitis" title="Lupus erythematosus panniculitis">Panniculitis</a></li></ul> <ul><li><a href="/wiki/Subacute_cutaneous_lupus_erythematosus" title="Subacute cutaneous lupus erythematosus">subacute</a>: <a href="/wiki/Neonatal_lupus_erythematosus" title="Neonatal lupus erythematosus">Neonatal</a></li></ul> <ul><li>ungrouped: <a href="/wiki/Chilblain_lupus_erythematosus" title="Chilblain lupus erythematosus">Chilblain</a></li> <li><a href="/wiki/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="/wiki/Tumid_lupus_erythematosus" title="Tumid lupus erythematosus">Tumid</a></li> <li><a href="/wiki/Verrucous_lupus_erythematosus" title="Verrucous lupus erythematosus">Verrucous</a></li> <li><a href="/wiki/Rowell%27s_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 class="mw-selflink selflink">Scleroderma</a>/<br /><a href="/wiki/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="/wiki/Localized_scleroderma" class="mw-redirect" title="Localized scleroderma">Localized scleroderma</a> <ul><li><a href="/wiki/Localized_morphea" class="mw-redirect" title="Localized morphea">Localized morphea</a></li> <li><a href="/wiki/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="/wiki/Generalized_morphea" class="mw-redirect" title="Generalized morphea">Generalized morphea</a></li> <li><a href="/wiki/Atrophoderma_of_Pasini_and_Pierini" class="mw-redirect" title="Atrophoderma of Pasini and Pierini">Atrophoderma of Pasini and Pierini</a></li> <li><a href="/wiki/Pansclerotic_morphea" class="mw-redirect" title="Pansclerotic morphea">Pansclerotic morphea</a></li> <li><a href="/wiki/Morphea_profunda" class="mw-redirect" title="Morphea profunda">Morphea profunda</a></li> <li><a href="/wiki/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="/wiki/Atrophy" title="Atrophy">Atrophic</a>/<br /><a href="/wiki/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="/wiki/Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosus</a></li> <li><a href="/wiki/Anetoderma" title="Anetoderma">Anetoderma</a> <ul><li><a href="/wiki/Schweninger%E2%80%93Buzzi_anetoderma" class="mw-redirect" title="Schweninger–Buzzi anetoderma">Schweninger–Buzzi anetoderma</a></li> <li><a href="/wiki/Jadassohn%E2%80%93Pellizzari_anetoderma" class="mw-redirect" title="Jadassohn–Pellizzari anetoderma">Jadassohn–Pellizzari anetoderma</a></li></ul></li> <li><a href="/wiki/Atrophoderma_of_Pasini_and_Pierini" class="mw-redirect" title="Atrophoderma of Pasini and Pierini">Atrophoderma of Pasini and Pierini</a></li> <li><a href="/wiki/Acrodermatitis_chronica_atrophicans" title="Acrodermatitis chronica atrophicans">Acrodermatitis chronica atrophicans</a></li> <li><a href="/wiki/Lipoatrophia_semicircularis" title="Lipoatrophia semicircularis">Semicircular lipoatrophy</a></li> <li><a href="/wiki/Follicular_atrophoderma" title="Follicular atrophoderma">Follicular atrophoderma</a></li> <li><a href="/wiki/Linear_atrophoderma_of_Moulin" title="Linear atrophoderma of Moulin">Linear atrophoderma of Moulin</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/Kyrle_disease" title="Kyrle disease">Kyrle disease</a></li> <li><a href="/wiki/Reactive_perforating_collagenosis" title="Reactive perforating collagenosis">Reactive perforating collagenosis</a></li> <li><a href="/wiki/Elastosis_perforans_serpiginosa" title="Elastosis perforans serpiginosa">Elastosis perforans serpiginosa</a></li> <li><a href="/wiki/Perforating_folliculitis" title="Perforating folliculitis">Perforating folliculitis</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/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="/wiki/Calcinosis_cutis" title="Calcinosis cutis">Calcinosis cutis</a></li> <li><a href="/wiki/Sclerodactyly" title="Sclerodactyly">Sclerodactyly</a></li> <li><a href="/wiki/Poikiloderma_vasculare_atrophicans" title="Poikiloderma vasculare atrophicans">Poikiloderma vasculare atrophicans</a></li> <li><a href="/wiki/Ainhum" title="Ainhum">Ainhum</a>/<a href="/wiki/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"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Systemic_connective_tissue_disorders" 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"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Systemic_connective_tissue_disorders" title="Template:Systemic connective tissue disorders"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Systemic_connective_tissue_disorders" title="Template talk:Systemic connective tissue disorders"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Systemic_connective_tissue_disorders" title="Special:EditPage/Template:Systemic connective tissue disorders"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Systemic_connective_tissue_disorders" style="font-size:114%;margin:0 4em">Systemic <a href="/wiki/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="/wiki/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="/wiki/Drug-induced_lupus_erythematosus" title="Drug-induced lupus erythematosus">Drug-induced SLE</a></li> <li><a href="/wiki/Libman%E2%80%93Sacks_endocarditis" title="Libman–Sacks endocarditis">Libman–Sacks endocarditis</a></li> <li><a href="/wiki/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="/wiki/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="/wiki/Myositis" title="Myositis">Myositis</a></li> <li><a href="/wiki/Dermatopolymyositis" title="Dermatopolymyositis">Dermatopolymyositis</a> <ul><li><a href="/wiki/Dermatomyositis" title="Dermatomyositis">Dermatomyositis</a>/<a href="/wiki/Juvenile_dermatomyositis" title="Juvenile dermatomyositis">Juvenile dermatomyositis</a></li> <li><a href="/wiki/Polymyositis" title="Polymyositis">Polymyositis</a>* <a href="/wiki/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%"><a class="mw-selflink selflink">Scleroderma</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="/wiki/Systemic_scleroderma" title="Systemic scleroderma">Systemic scleroderma</a> <ul><li><a href="/wiki/Progressive_systemic_sclerosis" class="mw-redirect" title="Progressive systemic sclerosis">Progressive systemic sclerosis</a></li> <li><a href="/wiki/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="/wiki/Overlap_syndrome" title="Overlap syndrome">Overlap syndrome</a> / <a href="/wiki/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="/wiki/Hypersensitivity" title="Hypersensitivity">hypersensitivity</a>/<a href="/wiki/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="/wiki/Sj%C3%B6gren_syndrome" 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="/wiki/IgG4-related_disease" title="IgG4-related disease">IgG4-related disease</a></li> <li><a href="/wiki/Beh%C3%A7et%27s_disease" title="Behçet's disease">Behçet's disease</a></li> <li><a href="/wiki/Polymyalgia_rheumatica" title="Polymyalgia rheumatica">Polymyalgia rheumatica</a></li> <li><a href="/wiki/Eosinophilic_fasciitis" title="Eosinophilic fasciitis">Eosinophilic fasciitis</a></li> <li><a href="/wiki/Eosinophilia%E2%80%93myalgia_syndrome" title="Eosinophilia–myalgia syndrome">Eosinophilia–myalgia syndrome</a></li> <li><a href="/wiki/Ehlers%E2%80%93Danlos_syndrome" title="Ehlers–Danlos syndrome">Ehlers–Danlos syndrome</a></li> <li><a href="/wiki/Fibrillin" title="Fibrillin">fibrillin</a> <ul><li><a href="/wiki/Marfan_syndrome" title="Marfan syndrome">Marfan syndrome</a></li> <li><a href="/wiki/Congenital_contractural_arachnodactyly" title="Congenital contractural arachnodactyly">Congenital contractural arachnodactyly</a></li></ul></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link 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