This article aims to familiarize the practitioner with systemic scleroderma and addresses the various decisions needed for an appropriate continuity of care with this difficult disease. This incurable condition can account for many months or even years of testing before a definitive diagnosis is made. These circumstances take an enormous toll on patients and their families. This article discusses the epidemiology, pathophysiology, signs and symptoms, differential diagnosis, diagnostic tests, and treatment plan for patients with systemic scleroderma. This complicated disease process requires not only that practitioners be intuitive but also that these patients' caregivers become familiar with this chronic and debilitating disease process.