A 74-year-old man with hypertension, type 2 diabetes (HbA1c 12 %), and chronic kidney disease (KDIGO IIb) presented to the dermatology emergency department with an eight-month history of progressive skin thickening. Lesions began on the posterior trunk and progressively generalized, accompanied by painful ulcerations on the limbs, joint stiffness, fixed contractures, and severely reduced mobility. He described intense pruritus and a sensation of being "trapped in his own skin."
