Salt-and-Pepper Skin Changes - Examination of the skin revealed areas of depigmentation with relative sparing of the perifollicular areas and preservation of pigmentation over the veins. The salt-and-pepper skin changes represent vitiligo-like depigmentation, which spares the perifollicular area. The capillary network of the hair follicles preserves melanogenesis and maintains pigmentation. #Clinical #Derm #PrimaryCare #Rheum #SaltPeppper #SaltAndPepper #PerifollicularSparing #Scleroderma #NEJM