Localized scleroderma: Skin changes are patchy and usually stay in the skin. Localized scleroderma does not involve the internal organs except perhaps the esophagus. Systemic scleroderma (systemic sclerosis): Can involve the joints, skin, heart, lungs, gastrointestinal tract, kidneys, bladder, nerves, muscles, blood vessels, joints, etc. The end result of this form of scleroderma is hardening and fibrosis of the organs. There are 2 major recognized patterns of systemic sclerosis – diffuse or limited disease. Diffuse: Skin thickening occurs rapidly and affects more skin than the limited form of the disease. Diffuse scleroderma patients have a higher risk of involving the internal organs than limited scleroderma patients. Limited: Skin thickening is less widespread (face, distal arms, hands, legs, and feet). Although internal organs are involved, they are less frequent and tend to be less severe than diffuse scleroderma.