“…Skin biopsies demonstrate dermal fibrosis with a significant increase in cellularity, but no inflammation (59). Often the cells are described as being spindle shaped (61,77), fibroblasts (6), fibroblast like (56), fibrohistiocytic (68,75,82), or "polygonal epitheliod fibroblasts" (6). With the use of light microscopy, the dermal collagen is notably increased (27), with bundles haphazardly arranged (56) or "disorganized" (48).…”