REPORT OF A CASE
A 46-year-old woman complained that for ten years her hands and feet became cold and purple in response to cold exposure and emotional stress. For the previous six years her hands had been persistently purple and cool. She also complained that her hands bruised easily. She denied pain or pallor, and had no history of erythema on rewarming. She had taken nifedipine (10 mg/d orally) for three months with no improvement in symptoms. Nicotinic acid therapy (250 mg orally twice daily) produced some improvement in vasospastic symptoms. There was no history of topical or systemic steroid use, smoking, or Cushing's syndrome.On physical examination, her hands and feet were reddish blue and blanched on diascopy. There was striking thinning of the skin with loss of normal skin markings. There were multiple 1- to 4-mm hemorrhagic macules on the fingers (Fig 1). Blisters, milia, periungual telangiectasias, sclerodactyly,