CASE
A 49-year-old woman was referred to dermatology for evaluation of changes to the skin of both hands that she first noticed several months earlier. At first, the changes were subtle and temporary, lasting for a few hours to a day or two. Over time, the condition grew more severe and lasted longer. Edema of the hands and fingers appeared first followed by a sudden whitening of the fingertips accompanied by pain during cold weather. The tips of her fingers became cyanotic, then red. These spells lasted for hours, were relieved by heat, and reappeared later.
Eventually, both of her hands became swollen, tiny red dilated blood vessels manifested on the cuticles, and longitudinal ridges appeared on her fingernails (Figure 1). The soft edema of her hands became firmer. Ironically, she began to receive compliments from friends and strangers about how young she looked.
On examination, her hands and fingers showed definite firm edema and curious pinpoint scars on her fingertips. Numerous dilated capillary loops could also be seen on the distal cuticles. Further history-taking revealed that she had recently begun to experience rather serious heartburn for the first time.
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