A 48-year-old man presented to the dermatology clinic with painful hand ulcerations. Initial symptoms had begun 6 months earlier and were associated with new-onset shortness of breath on exertion.
Progressively worsening ulcerations on the fingertips and dorsal surface of the hands, elbow and oral ulcerations, and a violaceous periorbital eruption had developed. The patient had no muscle weakness or arthritis.
What is the Diagnosis ?