Pursed lips and shiny taught facial skin are commonly seen in advanced cases of systemic sclerosis, as is the extensive immobilizing, subcutaneous fibrosis that creates a claw-like flexion deformity of the fingers. Note also the cutaneous ulcerations on the fingers which are a result of the ischemia caused by the sclerosis of dermal arterioles.

The other facial image shows the classic lupus malar "butterfly" rash of the face.

The four images of fingers show examples of Raynaud phenomenon, which is frequently the first manifestation of either disease. It is caused by exaggerated vasoconstriction of the digital arteries and arterioles. How this fits into the etiology of either disease is unknown. Note that Raynaud's phenomenon is common in the general population (~ 5%) so it is not diagnostic of collagen vascular disorders.

Both lupus and systemic sclerosis have significant effects on the skin.

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How would you characterize the abnormalities?