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Approximately 8 years ago, Cowper and colleagues described a scleromyxedema-like process in patients undergoing dialysis, characterized by “woody,” indurate, sometimes hyperpigmented plaques. Identification of systemic involvement prompted a change in the name of this condition from nephrogenic fibrosing dermopathy to nephrogenic systemic fibrosis (NSF). The histologic hallmarks were increased collagen thickness, increased hyaluronan, and numerous plump fibroblast-like cells. The clinical course is often progressive, with internal organ involvement, sometimes leading to death. Previous research established a link to exposure to the gadolinium-based contrast agent gadodiamide used in MRI. These investigators studied the mechanism behind this…