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A 57-year-old man attended a dermatologist because of progressive hardening of his skin, initially on the right arm and later on the lower legs. The process had recently resulted in limitation of movement of the right ankle and was impairing his ability to work as a tradesman. When seen by another dermatologist 4 years earlier, a skin biopsy from an indurated area on the right leg showed evidence of morphea, and a more recent review by a rheumatologist had uncovered a peripheral blood eosinophilia. He did not have Raynaud's phenomenon, joint problems, or other systemic symptoms. His general medical history was significant for type II diabetes mellitus, hypertension, and a myocardial infarct 6 years earlier. On physical examination, the most striking abnormalities were observed on the lower legs (Fig. 1). The more severely affected right leg revealed circumferential thickening and induration of the skin extending from FIGURE 1. Clinically, the skin of the lower legs was shiny, thickened, indurated, and bound down to deeper structures. FIGURE 2. At scanning magnification, the histopathological findings are characterized by thickening of collagen bundles in the deep dermis, fibrotic expansion of subcutaneous interlobular septa, and an accompanying perivascular and interstitial inflammatory infiltrate arrow (A). The infiltrate, best seen under high magnification, is composed of lymphocytes, plasma cells, and occasional eosinophils (B).