Extension-elicited blanching of the dorsal phalanges in systemic sclerosis - Video Data

Systemic sclerosis (SSc) is a multisystem disease that normally first manifests in the skin. To help differentiate early pathogenic phalangeal edema that often precedes finger skin thickening from normal variants, we report the clinical sign of extension-elicited blanching of the dorsal phalanges associated with SSc. We often observe this blanching phenomenon of the dorsal phalanges in our patients with early-stage disease (Video 1). However, attention to this clinical sign has been underreported and provides an additional clue toward diagnosing SSc.
To appreciate pathogenic phalangeal blanching associated with SSc, patients make a fist with their hands and hold it. Upon releasing the fist and fully extending the phalanges, blanching of the dorsal aspects of their fingers can be elicited. The blanching ranges from the metacarpophalangeal joints over the proximal phalanges and proximal interphalangeal joints to the middle phalanges. It can be present symmetrically in all five fingers but is often less prominent on the thumbs.