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HISTORY OF THE DISEASEA 13-year old patient with lesions on the right leg for the past two years, latterly affecting her upper and lower limbs and abdomen. She reported no systemic signs or symptoms. Past history of prurigo.Dermatological examination revealed clearly delimited, sclerotic, yellowish-brown plaques with a central depression and violet-colored border on the lower limbs and lower abdomen; erythematous lesions on the upper abdomen, livedo reticularis on the lower limbs and Raynaud's phenomenon on her hands (Figures 1-3). Laboratory exams were all within normal limits. Evaluation of antinuclear factor (ANF) showed titers of 1:80 with a fine dotted nuclear pattern. Biopsy of the erythematous and yellowish lesions showed skin with thickening of the collagen fibers enclosing the appendages, rare perivascular lymphocytes, thickening of connective fibers in the deep dermis and moderate perivascular lymphocytic infiltrate (Figure 4). Hematoxylin-eosin staining revealed very thick elastic fibers distributed throughout the entire dermis ( Figure 5). Treatment was initiated with systemic cor-FIGURE 4: : Excessive thickening of the skin with elastic fibers spread evenly throughout the dermis (H&E staining, 600X magnification)

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