3rd July 2023

You see a 65-year-old man in a rheumatology clinic. He has notable skin changes around his lips

You see a 65-year-old man in a rheumatology clinic. He has notable skin changes around his lips and a tightening of the skin on his hands. He also complains of some swallowing difficulties recently.  On examination he has microstomia.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.