How can scleroderma cause atrophy of the skin and tissues beneath it?

Scleroderma is a chronic disease characterized by the excessive deposition of collagen, the primary protein in connective tissues. While the disease is initially recognized by the thickening and tightening of the skin, advanced stages often lead to marked atrophy of the tissue and appendages of the true skin.123

The progression toward atrophy occurs as the targeted tissues become inflamed, irritated, and eventually scarred, causing them to lose their elasticity. In these advanced stages, the overlying epidermis may undergo atrophic thinning. Furthermore, the pathological process can extend beyond the skin, resulting in the atrophy of underlying fatty tissue and muscle. These degenerative changes are part of the broader spectrum of inflammatory and fibrotic damage that can affect the skin, joints, and internal organs in systemic forms of the disease.123