Many clinical manifestations of systemic sclerosis (scleroderma) often go unrecognized; yet they can cause significant morbidity and are challenging to manage. This article discusses osteolysis, avascular necrosis of the wrist, oral manifestations, erectile dysfunction, pharyngeal weakness, fecal incontinence, nonscleroderma renal disease, liver disease, thyroid disease, and neurological disease in the scleroderma patient.