Kylie is a 53-year-old retail worker who is brought in by her daughter for review of bilateral digital shortening, sclerodactyly, and pallor of the fingertips.

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<p>Kylie is a 53-year-old retail worker who is brought in by her daughter for review of bilateral digital shortening, sclerodactyly, and pallor of the fingertips.</p><p>Kylie reports many years of progressive thickening, hardening and stiffness of the fingers, Raynaud’s phenomenon, pain and fatigue.</p><p>There is no history of rash, trauma or significant occupational exposure. Kylie was adopted, so family history is unknown.</p><p>Kylie is a lifelong non-smoker who takes no medications and generally avoids seeking medical care. On examination, vital signs are normal.</p><p>There are four absent distal phalanges, and capillary nailfold abnormalities and ulcerations affecting several other fingers.</p><p>The skin of the face appears tight and hard. Blood tests reveal positive antinuclear and anti-Scl-70 antibodies, with weakly positive anti-Ro-52 antibodies.</p><p>X-ray of the left hand is pictured.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.