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The interaction of the common pathologic cascade with the skin-specific pathology of SSc. The SSc-specific common pathologic cascade is modified by keratinocytes and adipocytes. Keratinocytes produce various factors related to fibroblast activation. Adipocytes serve as a potential source of myofibroblasts by transdifferentiating into mesenchymal cells, and produce a variety of adipokines involved in SSc development.
