Salt-and-Pepper Skin Changes
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A 31-year-old man with an 8-month history of progressive shortness of breath and skin changes presented to the emergency department. Examination of the skin revealed areas of depigmentation with relative sparing of the perifollicular areas and preservation of pigmentation over the veins. A biopsy specimen of the forearm showed hyalinized collagen in the dermis that was consistent with scleroderma. Pigment loss and melanophages were observed in the papillary dermis. The salt-and-pepper skin changes represent vitiligo-like depigmentation, which spares the perifollicular area. The capillary network of the hair follicles preserves melanogenesis and maintains pigmentation. The pulmonary symptoms noted at the patient’s initial presentation were due to interstitial lung disease. The cutaneous and pulmonary findings were consistent with a diagnosis of scleroderma. Mycophenolate mofetil and prednisone were administered to treat both the cutaneous and the pulmonary symptoms, and the patient has had a partial response...

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