Depigmentation on the chest and nail folds

A woman, aged 38 years, complained of color loss on her cuticles and upper chest. Examination revealed bilateral puffy hands with depigmentation and dilated capillary loops of all proximal nail folds.

A sclerotic depigmented patch with circular islands of normal color was present over her mid-chest. Review of systems revealed Raynaud's phenomenon, as well as recent onset of dyspnea on exertion. ...