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Systemic scleroderma
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===Skin symptoms=== [[File:Systemic sclerosis finger.jpg|thumb|Clinical appearance of acrosclerotic piece-meal [[necrosis]] of the thumb in a patient with systemic sclerosis.]] [[File:Riehl Zumbusch Tafel LXVIII (1).jpg|thumb|Systemic scleroderma in the limbs, showing [[carcinoma]] subsequent to ulceration]] In the skin, systemic sclerosis causes hardening and scarring. The skin may appear tight, reddish, or scaly. Blood vessels may also be more visible. Where large areas are affected, fat and muscle wastage may weaken limbs and affect appearance. Patients report severe and recurrent [[itch]]ing of large skin areas. The severity of these symptoms varies greatly among patients: Some having scleroderma of only a limited area of the skin (such as the fingers) and little involvement of the underlying tissue, while others have progressive skin involvement.<ref>{{cite journal |vauthors=Hinchcliff M, Varga J |title=Systemic sclerosis/scleroderma: a treatable multisystem disease |journal=Am Fam Physician |volume=78 |issue=8 |pages=961–8 |date=October 2008 |pmid=18953973 }}</ref> Digital ulcers—open wounds especially on fingertips and less commonly the knuckles—are not uncommon.<ref>{{cite journal|last1=Abraham|first1=S|last2=Steen|first2=V|title=Optimal management of digital ulcers in systemic sclerosis|journal=Therapeutics and Clinical Risk Management|date=2015|volume=11|pages=939–47|doi=10.2147/TCRM.S82561|pmid=26109864|pmc=4474386|doi-access=free}}</ref>
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