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... erythema and edema, accentuated on the left eye, patchy gray to violaceous pigmented patches on forehead and glabella, and flat-topped, hyperkeratotic papules overlying the metacarpophalangeal and proximal interphalangeal joints (Fig. 1). Upon further inspection with capillaroscopy, periungual, dilated, looped telangiectasias were evident (Fig. 2). The patient denied proximal muscle weakness, fatigue, weight loss, shortness of breath, chest pain, or dyspnea on exertion. A punch biopsy above the left metacarpophalangeal joint was taken revealing perivascular lymphocytic infiltrate with epidermal hyperplasia, acanthosis, slight increase of papillary dermal mucin, and mild vacuolar ...
