The muscles may be
implicated independently of the skin, or simultaneously, and they
give the resemblance of rigor mortis. The whole skin is so hard
as to suggest the idea of a frozen corpse, without the coldness,
the temperature being only slightly subnormal. The skin can
neither be pitted nor pinched. As Crocker has well put it, when
the face is affected it is gorgonized, so to speak, both to the
eye and to the touch. The mouth cannot be opened; the lids
usually escape, but if involved they are half closed, and in
either case immovable. The effect of the disease on the
chest-walls is to seriously interfere with the respiration and to
flatten and almost obliterate the breasts; as to the limbs, from
the shortening of the distended skin the joints are fixed in a
more or less rigid position. The mucous membranes may be
affected, and the secretion of both sweat and sebum is diminished
in proportion to the degree of the affection, and may be quite
absent. The atrophic type of scleroderma is preceded by an edema,
and from pressure-atrophy of the fat and muscles the skin of the
face is strained over the bones; the lips are shortened, the gums
shrink from the teeth and lead to caries, and the nostrils are
compressed.
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