History:

Patient of Dr K Naing 47 years old,Female
Occupation : worker in a garment factory
hardening and thickening of the skin of the hands, forearms, face, neck, back, abdomen and feet for 3years.
Difficulty in opening the mouth(+)
Painful tip of the fingers at cold weather , shortening of breath (+).

Mask-like facial appearance
Microstomia with radial furrowing around the mouth.
Bilateral symmetrical extensive thickening and tightening of the skin of the hands, forearm, upper chest, abdomen and face
Cold tip of fingers
Rat-bite ulcers at the interdigital space of the fingers(Lt>Rt)
Multiple hypopigmented patches with perifollicular sparing(salt & pepper sign) distributed over the neck, upper chest, upper back, shoulder and face.

ANA(ANF,FANA)= positive
Homogeneous pattern 1:1280
Speckled pattern    fine speckled 1:1280
Nucleolar pattern    1:640