Clinical manifestation

Papular mucinosis (lichen myxedematosus) variant: dome-shaped and flesh-colored or erythematous papules, often in a pattern of parallel ridges, sometimes coalescing into grouped lichenoid papules, on dorsal hands, face, or extensor surfaces of the arms and legs; with extensive involvement, leonine faces and difficulty opening the mouth

Scleromyxedema variant: widespread, ery-thematous, indurated skin resembling scle-roderma, with diffuse tightness and decreased range of motion; systemic manifestations include restrictive and obstructive pulmonary dysfunction, cardiovascular abnormalities, and polyarthritis; gastrointestinal symptoms (most commonly dysphagia) related to deficient esophageal peristalsis; proximal muscle weakness, polyarthritis; organic brain syndrome; ectro-

Paradoxical fibrosarcoma 441

pion and corneal opacities; cardiovascular abnormalities

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