The spectrum of cutaneous findings in ScGVHD. Localized bound-down thickened hyperpigmented plaques on the thigh (A) and forearms (B) resemble morphea/localized scleroderma. Widespread shiny indurated skin on the torso resembles generalized systemic sclerosis and may lead to restricted chest wall expansion (C). Subcutaneous and fascial fibrosis results in an irregular, rippled appearance to the skin, resembling eosinophilic fasciitis (D) and may result in joint contractures, including the prayer sign (E). Skin breakdown and poor wound healing is a complication of long-standing ScGVHD, particularly of the lower extremities, and may lead to increased risk of systemic infection (F).