Lindsay's nails in early limited cutaneous systemic sclerosis with severe digital vasculopathy

A 63 year-old male with diet-controlled type II diabetes mellitus, was referred with a 2-year history of Raynaud's phenomenon (episodic white, blue and red discolouration of the fingers in response to cold exposure), digital ulceration and puffy fingers. Examination of the fingers revealed features of systemic sclerosis (SSc) with digital pitting and grade 3 sclerodactyly. The nails appeared abnormal, with proximal leukonychia with complete loss of the lunula, and distal hyperpigmentation occupying over 50% of the nailbed (A).