More than just skin deep

A 65-year-old woman complains of patchy discolouration and hardening of the skin over the anterior chest wall and abdomen (Figure 1). Although not dyspnoeic at rest, she reports difficulty expanding her chest fully when taking a deep breath. She is otherwise well and on no regular medications. What is the most likely diagnosis?

Scleroderma (morphoea)

Scleroderma/morphoea is the umbrella term for sclerosis (fibrosis) confined to the skin. The most common form of scleroderma is