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Yazdanparast T, Mohseni A, Dehghan KS, Delavar S, Firooz A. High-frequency ultrasound evaluation of morphea: Retrospective analytical study. Skin Res Technol 2024; 30:e13818. [PMID: 38924131 PMCID: PMC11197076 DOI: 10.1111/srt.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND To date, there are no accepted outcome measures to monitor morphea, and consensus on specific monitoring criteria for morphea remains elusive. A few studies have assessed the criterion validity of skin ultrasound in morphea. So, in this study, we approach ultrasound findings in morphea lesions. MATERIAL AND METHODS This was a retrospective-analytical study conducted between December 2021 and May 2023. Patients were clinically evaluated at a dermatology outpatient clinic and then referred for high-frequency ultrasound (HF-US) evaluation and were selected to be included in this study. The lesions were confirmed by histopathology as well. Sonographic evaluations were performed on the lesion site and the symmetrical uninvolved other side. Dermal thickness and dermal echogenicities were recorded. Statistical analysis of group differences was performed by using the 2-tailed Student t-test. A p-value of less than 0.05 was considered statistically significant. RESULTS Forty-one morphea lesions in the inflammatory phase of 27 patients were included in the study. The mean dermal thickness of morphea lesions was 1107.97 ± 414.3 and the mean dermal thickness of the control side was 1094.65 ± 331.06, The difference between these two variables was not statistically significant. The mean dermal density of lesions was 49.13 ± 18.97 and the mean dermal density of the control side was 52.22 ± 25.33. The difference between these two variables was not statistically significant. CONCLUSION This study shows that HF-US indicated increasing dermal thickness and reducing the dermal density of the morphea lesions in the inflammatory phase confirmed with the histopathology.
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Affiliation(s)
- Taraneh Yazdanparast
- Center for Research & Training in Skin Diseases & LeprosyTehran University of Medical SciencesTehranIran
| | - Alireza Mohseni
- Department of RadiologyJohn Hopkins UniversityBaltimoreMarylandUSA
| | - Kobra Soltan Dehghan
- Center for Research & Training in Skin Diseases & LeprosyTehran University of Medical SciencesTehranIran
| | - Shohreh Delavar
- Center for Research & Training in Skin Diseases & LeprosyTehran University of Medical SciencesTehranIran
| | - Alireza Firooz
- Center for Research & Training in Skin Diseases & LeprosyTehran University of Medical SciencesTehranIran
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2
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Sami H, Sami F, Sami SA, Nashwan AJ. A Severe Case of Overlap of Morphea and Eosinophilic Fasciitis after Burn Injuries. Case Rep Rheumatol 2024; 2024:3123953. [PMID: 38774817 PMCID: PMC11108696 DOI: 10.1155/2024/3123953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Background Generalized morphea is a rare fibrosing skin illness that progresses from erythematous, violet-colored skin patches to sclerotic plaques. Another uncommon immune-mediated connective tissue disease called eosinophilic fasciitis (EF) evolves to cause sclerosis and woody skin induration. The coexistence of the two is extremely rare and has a poorer prognosis. Our case report is one of the first to report burn injuries as a trigger factor for EF and generalized morphea overlap. Case Presentation. A 36-year-old man presented with acute onset of rapidly progressing skin thickening, tender edema, and skin contractures involving all extremities, shortly after enduring burn injuries from a gasoline explosion. Workup was remarkable for peripheral eosinophilia, hypergammaglobulinemia, and elevated C-reactive protein. Skin biopsy demonstrated sclerodermoid changes and sclerotic thickening of subcutaneous fibrous septa associated with stromal mucin, dermal perivascular, diffuse lymphoplasmacytic infiltrate with eosinophils, decreased CD34 expression, and increased factor XIIIa. He was subsequently diagnosed with an overlap of generalized morphea and eosinophilic fasciitis. The patient had only limited improvement with steroids, methotrexate, mycophenolate mofetil, and intralesional triamcinolone acetonide injections. Conclusion Generalized morphea with concomitant EF indicates some degree of therapeutic resistance and poor prognosis with a low quality of life. Burn injuries can be a trigger factor for this overlap syndrome. Prompt identification of at-risk individuals and initiating aggressive management are necessary.
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Affiliation(s)
- Hania Sami
- Shalamar Medical and Dental College, Lahore, Pakistan
| | - Faria Sami
- Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Shahzad Ahmed Sami
- Internal Medicine, Trinity Health Oakland Campus, Pontiac, Michigan, USA
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3
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Zhu P, Deng W. Single-Cell RNA-Sequencing Analyses Identify APLNR, INS-IGF2, RGCC Genes May Be Involved in the Pathogenesis of Systemic Sclerosis Skin. Clin Cosmet Investig Dermatol 2024; 17:1059-1069. [PMID: 38742168 PMCID: PMC11090198 DOI: 10.2147/ccid.s456593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
Background Systemic sclerosis represents a persistent autoimmune disorder marked with fibrosis affecting both skin and other organs, which leads to a diminished quality of life and increased mortality. The affected skin provides a valuable opportunity to explore the pathogenesis of systemic sclerosis. Nevertheless, the roles of various cell populations within scleroderma remain intricate. Methods We conducted a comprehensive reanalysis of recently published single-cell RNA-sequencing data from skin tissue cells in scleroderma. Through the utilization of Seurat, irGSEA, AUCell packages, and WGCNA analysis, we aimed to unveil crucial genes associated with the disease's etiological factors. Our investigation involved the characterization of heterogeneous pathway activities in both healthy and SSc-affected skin. Furthermore, we employed immunofluorescence techniques to validate the expression patterns of hub genes and differentially expressed genes. Results The Endothelial-to-Mesenchymal Transition (EndMT) pathway was upregulated in SSc skin. Notably, the M4 module within Endothelial cell subpopulation 1 exhibited a strong association with EndMT. Furthermore, we identified three overexpressed genes (APLNR, INS-IGF2, RGCC) that demonstrated a significant correlation with EndMT. Importantly, their expression levels were markedly higher in skin of individuals with SSc when compared to healthy controls. Conclusion APLNR, INS-IGF2 and RGCC serve as potential key players in the pathogenesis of SSc skin through EndMT-dependent mechanisms.
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Affiliation(s)
- Peiqiu Zhu
- Department of Dermatology and Venereology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weiwei Deng
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, People’s Republic of China
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Mihailescu M, Abbas M. A difficult diagnosis of eosinophilic fasciitis: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241231384. [PMID: 38665934 PMCID: PMC11044792 DOI: 10.1177/2050313x241231384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/11/2023] [Indexed: 04/28/2024] Open
Abstract
Eosinophilic fasciitis can be a debilitating diagnosis and is often delayed given its similarities to other sclerotic conditions including morphea, such as bound-down indurated skin and inflammation and sclerotic thickening of tissue layers on histopathology. Delaying treatment can lead to joint contracture and residual hardness in skin which has both cosmetic and functional implications. Therefore, finding the definitive diagnosis and differentiating from other sclerotic diseases is important early in the disease course. We present a case of a 77-year-old female with a generalized rash on her back and extremities, and progressive symptoms of pain, joint contractures, and limited movement, which highlights the challenges in diagnosis and management given clinical and histological parallels between eosinophilic fasciitis and morphea.
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Affiliation(s)
- Mara Mihailescu
- University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Mariam Abbas
- University of Saskatchewan College of Medicine, Department of Medicine, Division of Dermatology, Saskatchewan, Canada
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Koizumi S, Inafuku K. A case of overlap between eosinophilic fasciitis and generalized morphea. Dermatol Reports 2024; 16:9802. [PMID: 38623365 PMCID: PMC11017715 DOI: 10.4081/dr.2023.9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 04/17/2024] Open
Abstract
Not available
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Affiliation(s)
- Shigeru Koizumi
- Division of Dermatology, Kimitsu Chuo Hospital, Kisarazu
- Division of Dermatology, Asahi General Hospital, Asahi, Japan
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6
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Yang Y, Zhang L, Li JH. Segmental Skin Induration in a Boy. JAMA Dermatol 2024; 160:354-355. [PMID: 38198132 DOI: 10.1001/jamadermatol.2023.4235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
An 11-year-old boy presented with progressive unilateral skin hardening on his right thigh and buttock for 7 years. What is your diagnosis?
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Affiliation(s)
- Yang Yang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang China
- Key Laboratory of Immunodermatology, Ministry of Education and NHC, Shenyang, China
- National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, Shenyang, China
| | - Lan Zhang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang China
- Key Laboratory of Immunodermatology, Ministry of Education and NHC, Shenyang, China
- National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, Shenyang, China
| | - Jiu-Hong Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang China
- Key Laboratory of Immunodermatology, Ministry of Education and NHC, Shenyang, China
- National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, Shenyang, China
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7
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Venetsanopoulou AI, Mavridou K, Pelechas E, Voulgari PV, Drosos AA. Development of Morphea Following Treatment with an ADA Biosimilar: A Case Report. Curr Rheumatol Rev 2024; 20:451-454. [PMID: 38243962 DOI: 10.2174/0115733971266803231117072453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Tumor necrosis factor alpha (TNFα) is a pivotal cytokine involved in the pathogenesis of certain inflammatory diseases, such as rheumatoid arthritis (RA), spondyloarthropathies, and inflammatory bowel diseases. In the last two decades, TNFα inhibitors (TNFi) have revolutionized the treatment and outcome of the above disorders. However, the use of TNFi has been associated with the development of many autoimmune phenomena and paradoxical skin manifestations that may present as the same type of clinical indications for which the TNFi effectively used. Thus, they may display as arthritis, uveitis, colitis, psoriasis, and several other cutaneous clinical manifestations, among them the development of morphea, a localized scleroderma skin lesion. CASE PRESENTATION We describe a 58-year-old woman with seronegative RA, refractory to methotrexate, who was treated with ABP-501 (Hefiya), an adalimumab (ADA) biosimilar and developed an oval-shaped, deep skin lesion of approximately 3.5cm in size, affecting the left part of her back compatible with morphea 3 months after the initiation of therapy. ADA biosimilar was discontinued and two months later, she had substantial skin improvement. CONCLUSION This is the first report of morphea manifestation during TNFi biosimilar since the patient had no other trigger factors for morphea development like trauma and infections. Physicians dealing with patients treated with TNFi biosimilars should be aware of paradoxical skin reactions, among them morphea; thus, close monitoring, a minute and careful clinical examination, and a follow- up check are required.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Eleftherios Pelechas
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Angelopoulos A, Kouverianos I, Daoussis D. Is there a Role for Anti-IL-5 Therapies in Eosinophilic Fasciitis? Mediterr J Rheumatol 2023; 34:414-417. [PMID: 38282929 PMCID: PMC10815516 DOI: 10.31138/mjr.301223.itr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Eosinophilic Fasciitis (EF) is a rare disease, originally proposed as "diffuse fasciitis with eosinophilia" by Shulman in 1974. Symptoms of EF include peripheral eosinophilia accompanied by symmetrical inflammation of the subcutaneous fascia and muscle, usually locating in the upper arms or thighs. There is no approved standard of care treatment. Methods Taking into account that eosinophils may be pathogenetically involved in EF, we performed a review on Medline focusing on anti-Interleukin-5 (IL-5) therapies in EF. Results Only one case of a patient with EF has been reported who was successfully treated with reslizumab, an anti-IL-5 therapy. The patient had EF refractory to the commonly used immunosuppressive treatment but when reslizumab was added, the patient experienced remission of her symptoms. Discussion The exact aetiology of EF is still unclear, and many therapeutic approaches have been tested. Commonly used immunosuppressive agents, such as corticosteroids are not always effective and associate with significant side effects. Eosinophils seem to have a role in the pathogenesis of the disease; anti-eosinophilic therapies targeting IL-5/IL-5 Receptor could be an attractive alternative for the treatment of the disease.
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Affiliation(s)
| | | | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
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9
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Guo Q, Cen J, He M, Huang D, Tang Z, Xiong H. Fractional erbium:yttrium aluminum garnet laser in the treatment of morphea mouse model. J Cosmet Dermatol 2023; 22:3282-3290. [PMID: 37326004 DOI: 10.1111/jocd.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To assess the efficiency and the mechanism of fractional erbium:yttrium aluminum garnet (Er:YAG) laser for the treatment of morphea in mouse model. BACKGROUND Morphea is a rare autoimmune disease characterized by excessive collagen deposition in skin. Fractional Er:YAG laser treatment is a promising treatment to improve morphea, despite limited studies about the therapeutic effect and underlying mechanism. METHODS The mouse model of morphea was established by subcutaneously injecting with bleomycin (BLM). A total of 24 mice received fractional Er:YAG laser treatment once a week for 4 weeks. Objective measurement employed was ultrasonic imaging to measure dermal thickness. Subjective measures included scoring according to the adjusted Localized morphea Cutaneous Assessment Tool (LoSCAT); hematoxylin and eosin (H&E) staining to evaluate the histological grade of fibrosis; and quantitative morphometric studies to determine the expression of transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase-1 (MMP1) by immunohistochemistry. RESULTS In this self-controlled study, fractional Er:YAG laser treatment significantly ameliorate the severity of morphea, including lower clinical score (p < 0.01), decreased dermal thickness (p < 0.001), declined histological grade of fibrosis (p < 0.001), increased MMP1 (p < 0.001), and reduced TGF-β1 (p < 0.01) expression. CONCLUSIONS We found that fractional Er:YAG laser treatment of morphea has good clinical, ultrasonic, and histopathologic efficacy, which may be a promising treatment in the future.
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Affiliation(s)
- Qing Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junjie Cen
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingjie He
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Danqi Huang
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zengqi Tang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiong
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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10
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Wróblewska A, Polańska A, Mojs E, Żaba R, Adamski Z, Dańczak-Pazdrowska A. Disturbances of the stomatognathic system and possibilities of its correction in patients with craniofacial morphea. Postepy Dermatol Alergol 2023; 40:592-598. [PMID: 38028421 PMCID: PMC10646717 DOI: 10.5114/ada.2023.131865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
Morphea en coup de sabre and progressive hemifacial atrophy are extremely rare connective tissue disorders causing facial deformity. In extreme cases, morphological disorders are accompanied by symptoms of a clear impairment of the stomatognathic system. The aetiology of the above-mentioned diseases is still unknown. Properly planned therapy in the field of maxillofacial orthopaedics makes it possible to correct the asymmetric pattern of hard tissue growth and thus enable rehabilitation. The task of augmentation techniques is the volumetric supplementation of tissue defects resulting from atrophic processes. The degree of destruction and the extent of changes determine the method of correction. Mild and moderate defects are treated mainly with biomaterials and autologous adipose tissue. The severe course of hemifacial atrophy and morphea en coup de sabre and the associated significant tissue atrophy necessitate the search for more complex methods of treatment. In this paper, we summarize the disturbances of the stomatognathic system in patients with craniofacial morphea, together with an analysis of current treatment options.
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Affiliation(s)
- Agnieszka Wróblewska
- Student of Postgraduate Studies Facial Aesthetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Joly-Chevrier M, Gélinas A, Ghazal S, Moussa S, McCuaig CC, Piram M, Mereniuk A, Litvinov IV, Osman M, Pehr K, Netchiporouk E. Morphea, Eosinophilic Fasciitis and Cancer: A Scoping Review. Cancers (Basel) 2023; 15:4450. [PMID: 37760419 PMCID: PMC10526289 DOI: 10.3390/cancers15184450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Morphea is an autoimmune fibrotic skin disease. Eosinophilic fasciitis (EF) is considered to belong to the severe spectrum of morphea. We conducted a scoping review assessing the risk of secondary cancer among morphea/EF patients, paraneoplastic morphea/EF and morphea/EF developing secondary to cancer therapy. The search was conducted using MEDLINE, Embase, Cochrane databases for articles published from inception to September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines with no language or date restrictions. Two hundred and one studies were included. Of these, 32 studies reported on secondary cancer in morphea/EF patients, 45 on paraneoplastic morphea/EF and 125 on cancer-treatment-induced morphea/EF. While the current evidence remains limited, data suggest an increased risk of secondary cutaneous and possibly pancreatic malignancy in morphea patients, particularly the generalized subtype. There were insufficient data for EF. On the other hand, paraneoplastic morphea was anecdotal, whereas several observational studies suggested that ~10% of EF cases may be paraneoplastic, primarily in the context of hematologic malignancies. Radiotherapy-induced morphea is rare, seen in ~0.2% of treated patients and is usually localized to the treatment site, except in patients with pre-existing autoimmunity. While chemotherapy-induced cases are reported, immunotherapy morphea/EF cases are emerging and are preferentially seen with PD-1 and not CTLA-4 inhibitors. This study is limited by the type of articles included (case reports, case series and observational studies), and hence, additional research on this important topic is needed.
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Affiliation(s)
| | - Alexa Gélinas
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Stephanie Ghazal
- Division of Dermatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Sarah Moussa
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Catherine C. McCuaig
- Division of Pediatric Dermatology, Sainte-Justine Hospital, Montreal, QC H3T 1C5, Canada
| | - Maryam Piram
- Division of Pediatric Dermatology, Sainte-Justine Hospital, Montreal, QC H3T 1C5, Canada
| | - Alexandra Mereniuk
- Division of Dermatology, Sacre Coeur Hospital, Montreal, QC H4J 1C5, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Kevin Pehr
- Division of Dermatology, Jewish General Hospital, McGill University, Montreal, QC H3N 1V4, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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Wosiak A, Biernacka-Zielińska M, Roszkiewicz J, Smolewska E. Diffuse fasciitis with eosinophilia in boys: a case-based review. Rheumatol Int 2023; 43:1755-1764. [PMID: 37316632 PMCID: PMC10348932 DOI: 10.1007/s00296-023-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Diffuse fasciitis with eosinophilia (EF) is a rare condition classified as a part of the connective tissue disorders. The clinical presentation of this condition can be diverse, however the main symptoms include symmetrical swelling and hardening of distal parts of limbs accompanied by peripheral eosinophilia. The diagnostic criteria are not specified. In inconclusions cases Magnetic Resonance Imaging (MRI) and skin to muscle biopsy may be useful. The pathogenesis and ethiology remain unknown, but extensive physical exertion, certain infectious factors, such as Borrelia burgdorferi, or medications may serve as a trigger. EF affects equally women and men, mainly in their middle age, however the disease can occur at any age. The standard therapy contents gluccocorticosteroids. As a second-line treatment, methotrexate is usually chosen. In this article we compare world reports of EF in paediatric patients with the cases of two adolescent male patients recently hospitalized in the Department of Paediatric Rheumatology.
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Affiliation(s)
- Agnieszka Wosiak
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Małgorzata Biernacka-Zielińska
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| | - Justyna Roszkiewicz
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| | - Elżbieta Smolewska
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
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13
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Zhang F, Li J, Zhao Q, Liu H, Zhang F. Study about evaluation of efficacy of methotrexate in localized scleroderma using ultrasonography. Skin Res Technol 2023; 29:e13300. [PMID: 36973989 PMCID: PMC10155795 DOI: 10.1111/srt.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The treatment and curative effect evaluation of localized scleroderma (LS) still perplexes many clinical workers. PURPOSE To investigate the efficiacy of methotrexate in the treatment of LS by the evaluation of ultrasonography. METHODS A prospective study enrolled 10 patients treated with MTX for at least 6 months was conducted. Treatment outcome was evaluated by a clinical score and 15-MHz ultrasonography. Safety assessment included the monitoring of adverse drug reactions and clinical laboratory examinations. RESULTS Eight of the 10 patients achieved clinical remission only with MTX. One patient was relieved after MTX combined with corticosteroids, while another one does not improve after the treatment of mycophenolate mofetil and corticosteroids. The effective rate of MTX is 80%. Nine patients were significantly improved with a decrease of the Localized Scleroderma Cutaneous Assessment Tool (the mean score of the LoSCAT cutaneous activity dropped from 5.2 to 1.0, p < 0.001, the mean score of the LS cutaneous damage dropped from 4.3 to 2.3, p = 0.002). The average difference of thickness between skin lesions and normal skin evaluated by ultrasonography decreased from 0.13 cm to 0.04 cm (p = 0.009) in eight patients. No serious adverse reactions occurred. CONCLUSION Methotrexate is a safe and effective treatment for patients with LS. Ultrasonography can be considered as an efficient assessment tool for evaluation LS.
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Affiliation(s)
- Fan Zhang
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Jianke Li
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Qing Zhao
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
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14
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Papara C, De Luca DA, Bieber K, Vorobyev A, Ludwig RJ. Morphea: The 2023 update. Front Med (Lausanne) 2023; 10:1108623. [PMID: 36860340 PMCID: PMC9969991 DOI: 10.3389/fmed.2023.1108623] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Morphea, also known as localized scleroderma, is a chronic inflammatory connective tissue disorder with variable clinical presentations, that affects both adults and children. It is characterized by inflammation and fibrosis of the skin and underlying soft tissue, in certain cases even of the surrounding structures such as fascia, muscle, bone and central nervous system. While the etiology is still unknown, many factors may contribute to disease development, including genetic predisposition, vascular dysregulation, TH1/TH2 imbalance with chemokines and cytokines associated with interferon-γ and profibrotic pathways as well as certain environmental factors. Since the disease may progress to permanent cosmetic and functional sequelae, it is crucial to properly assess the disease activity and to initiate promptly the adequate treatment, thus preventing subsequent damage. The mainstay of treatment is based on corticosteroids and methotrexate. These, however, are limited by their toxicity, especially if applied long-term. Furthermore, corticosteroids and methotrexate often do not sufficiently control the disease and/or the frequent relapses of morphea. This review presents the current understanding of morphea by discussing its epidemiology, diagnosis, management and prognosis. In addition, it will describe recent pathogenetic findings, thus proposing potential novel targets for therapeutic development in morphea.
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Affiliation(s)
- Cristian Papara
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany,*Correspondence: Cristian Papara, ✉
| | - David A. De Luca
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Artem Vorobyev
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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15
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Chebli de Abreu N, Didier Maciel F, do Rosário E Souza EJ, Batista Perdigão Mendes AJ, Lyon S. A rare and challenging presentation of adult-onset pansclerotic morphea. J Eur Acad Dermatol Venereol 2023; 37:e218-e220. [PMID: 35971896 DOI: 10.1111/jdv.18522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/05/2022] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | - Sandra Lyon
- Department of Dermatology, Hospital Eduardo de Menezes, Belo Horizonte, Brazil
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16
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Abduelmula A, Rankin BD, Riaz S, Ross N, Luca NJ, Prajapati VH. Management of morphea with systemic immunosuppressive therapies: An evidence-based review. J Am Acad Dermatol 2023; 88:467-469. [PMID: 35716832 DOI: 10.1016/j.jaad.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Brian D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saba Riaz
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Ross
- Western School of Business, Department of Business, Edmonton, Alberta
| | - Nadia J Luca
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Department of Pediatrics, Section of Pediatric Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Vimal H Prajapati
- Department of Pediatrics, Section of Community Pediatrics, University of Calgary, Calgary, Alberta, Canada; Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada.
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17
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Mazilu D, Boltașiu (Tătaru) LA, Mardale DA, Bijă MS, Ismail S, Zanfir V, Negoi F, Balanescu AR. Eosinophilic Fasciitis: Current and Remaining Challenges. Int J Mol Sci 2023; 24:ijms24031982. [PMID: 36768300 PMCID: PMC9916848 DOI: 10.3390/ijms24031982] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Eosinophilic fasciitis (EF), defined as diffuse fasciitis with eosinophilia by Shulman in 1974, is a disease with unknown etiology and whose pathogenesis is still being researched. The diagnosis is based on the clinical aspects (skin induration with an "orange peel" appearance), the lab results (eosinophilia, increased inflammatory markers), the skin biopsy with the pathognomonic histopathological result, as well as the typical MRI changes. The treatment includes glucocorticoids and immunosuppressive drugs. Due to severe refractory cases, the treatment remains a challenge. EF is still a disease with potential for further research.
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Affiliation(s)
- Diana Mazilu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Laura Alina Boltașiu (Tătaru)
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Denise-Ani Mardale
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
| | - Maria Silviana Bijă
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Sermina Ismail
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Violeta Zanfir
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Florentina Negoi
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Andra Rodica Balanescu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
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18
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Bosseila M, Okail A, Sayed S, Saleh MA. Comparison of vascular endothelial growth factor expression between lesional and non-lesional skin in patients with morphea: a dermoscopy-guided immunohistochemical study. Arch Dermatol Res 2023; 315:61-66. [PMID: 35064289 DOI: 10.1007/s00403-021-02315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/18/2021] [Accepted: 12/07/2021] [Indexed: 01/12/2023]
Abstract
Morphea is an inflammatory fibrosing disease, initiated by vascular injury resulting in increased collagen formation and decreased collagen degradation. This study was designed to evaluate the role of angiogenic vascular endothelial growth factor (VEGF) in the vascular changes which are dermoscopically evident in morphea lesions, compared with that in non-lesional skin, by assessing its expression immunohistochemically on tissue blood vessels. Twenty patients with morphea were subjected to clinical and dermoscopic examinations. Two skin biopsies from lesional and non-lesional skin were obtained and stained with hematoxylin and eosin (H&E) and immunohistochemically with VEGF. Dermoscopic examination showed linear blood vessels in 90% of the lesions. No significant difference in the number of VEGF-stained and unstained blood vessels, was observed between the lesional and non-lesional skin (p = 0.475 and 0.191, respectively). A weak inverse correlation was found between the total number of blood vessels positive for VEGF and the disease duration, (r = - 0.48; p = 0.032). Significant differences were found between different stages of morphea and total number of blood vessels negative for VEGF, (p = 0.017). In conclusion, VEGF immunostaining, which represents the newly formed blood vessels, showed no difference between lesional and non-lesional skin in patients with morphea. Thus, the dermoscopically observable blood vessels in lesions compared with non-lesional skin are not due to angiogenesis, but rather due to the thinning and atrophy of the overlying epidermis in morphea cases, rendering the blood vessels more obvious.
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Affiliation(s)
- Manal Bosseila
- Department of Dermatology, Faculty of Medicine, Cairo University School of Medicine, Kasr Al Ainy Hospital, Cairo, PO 11956, Egypt
| | - Amira Okail
- Department of Dermatology, Faculty of Medicine, Cairo University School of Medicine, Kasr Al Ainy Hospital, Cairo, PO 11956, Egypt
| | - Safinaz Sayed
- Department of Histology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwah Adly Saleh
- Department of Dermatology, Faculty of Medicine, Cairo University School of Medicine, Kasr Al Ainy Hospital, Cairo, PO 11956, Egypt.
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19
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Owen JJ, Saad S, Bicknell LM. Rare presentation of calcification associated with long‐standing linear morphea. Int J Dermatol 2022; 62:803-804. [PMID: 36416615 DOI: 10.1111/ijd.16524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Saadeddine Saad
- Baylor Scott & White Specialty Care Center Dermatology Clinic Temple TX USA
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20
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Tognetti L, Marrocco C, Carraro A, Guerrini G, Mariotti GI, Cinotti E, Rubegni P. Clinical and laboratory characterization of patients with localized scleroderma and response to UVA-1 phototherapy: In vivo and in vitro skin models. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:531-540. [PMID: 35324032 PMCID: PMC9790552 DOI: 10.1111/phpp.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND/PURPOSE Localized scleroderma (LS) is a rare disease leading to progressive hardening and induration of the skin and subcutaneous tissues. LS is responsive to UVA-1 phototherapy, though its exact mechanism of action dermal fibrosis is yet to be fully elucidated. We aimed to investigate the molecular changes induced by UVA-1 rays in human primary fibroblasts cultures. METHODS A total of 16 LS patients were treated with medium-dose UVA-1 phototherapy. At baseline, during and after therapy, Localized Scleroderma Assessment Tool, Dermatology Life Quality Index and lesions' staging and mapping were performed along with high-frequency ultrasound (HFUS) examination for dermal thickness assessment. Gene expression analysis for 23 mRNA transcripts, in vitro UVA-1 irradiation and viability tests were realized on lesional fibroblasts' primary cultures, before and 3 months after therapy. RESULTS The dermal thickness, the LoSCAT and the DLQI progressively decreased starting from the last phototherapy session up to the 6 and 9 month follow-ups (-57% and -60%, respectively). Molecular gene analysis (rt-PCR) revealed that UVA-1 phototherapy exerts multiple effects: the activation of specific anti-fibrotic pathways (e.g., overexpression of CTHRC1 and metalloproteases 1, 2, 7, 8, 9, 12, suppression of TIMP-1), the downregulation of peculiar pro-fibrotic pathways (e.g., downregulation of TGF-ß, TGF-ßrII, Grb2, SMAD 2/3, TNRSF12A, CTGF) through a significant overexpression of IL-1ß; the stabilization of collagen synthesis acting on genes COL1A1, COL3A1, COL8A1, COL10A1, COL12A1. CONCLUSION UVA-1 phototherapy adds significant benefits in local tissue remodeling, rebalancing the alteration between pro-fibrotic and anti-fibrotic pathways; these changes can be well monitored by HFUS.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank Unit, Department of Clinical Surgical and Neuro‐sciencesUniversity of SienaSienaItaly
| | - Camilla Marrocco
- Dermatology Unit and Skin Bank Unit, Department of Clinical Surgical and Neuro‐sciencesUniversity of SienaSienaItaly
| | - Andrea Carraro
- Dermatology Unit and Skin Bank Unit, Department of Clinical Surgical and Neuro‐sciencesUniversity of SienaSienaItaly
| | - Giuditta Guerrini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - GIancarlo Mariotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical Surgical and Neuro‐sciencesUniversity of SienaSienaItaly
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical Surgical and Neuro‐sciencesUniversity of SienaSienaItaly
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank Unit, Department of Clinical Surgical and Neuro‐sciencesUniversity of SienaSienaItaly
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21
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Araneda-Ortega P, Poblete-Villacorta MJ, Muñoz-López C, Vera-Kellet C, Wortsman X. Morphea After Liposuction Ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2629-2635. [PMID: 35023212 DOI: 10.1002/jum.15940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Liposuction is a common aesthetic procedure; however, to date, liposuction has not been linked to morphea. The aim was to review cases with a history of liposuction that presented active morphea lesions in the same surgery regions and were confirmed by ultrasound and histology. A retrospective descriptive analysis of the clinical, ultrasonographic, and pathology database took place (2014-2020). Eleven patients met the criteria. Ultrasound supported the diagnosis, and the ultrasonographic signs of activity in these cases matched the features described in the literature in 100% of cases. In summary, morphea may appear after liposuction and ultrasound can support its early detection.
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Affiliation(s)
- Paulina Araneda-Ortega
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Camila Muñoz-López
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Vera-Kellet
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ximena Wortsman
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
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22
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Sonoda M, Ishimura M, Eguchi K, Shiraishi A, Sakai Y, Urabe K, Ohga S. High-dose immunoglobulin therapy for steroid-resistant myositis in juvenile localized scleroderma. Pediatr Neonatol 2022; 63:542-544. [PMID: 35803858 DOI: 10.1016/j.pedneo.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 01/07/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Motoshi Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Katsuhide Eguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Shiraishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazunori Urabe
- Department of Dermatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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23
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Naschitz JE. Clinical guide to eosinophilic fasciitis: straddling dermatology and rheumatology. Expert Rev Clin Immunol 2022; 18:649-651. [PMID: 35575016 DOI: 10.1080/1744666x.2022.2078309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jochanan E Naschitz
- Bait Balev Nesher and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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24
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Wang L, Lv S, Lin W, Yang D. Autologous Concentrated Growth Factor Used to Treat Linear Scleroderma En Coup de Sabre: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:675-679. [PMID: 35444437 PMCID: PMC9015785 DOI: 10.2147/ccid.s356972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
Abstract
Linear scleroderma en coup de sabre (LSCS) is a variant of localized scleroderma associated with band-like fibrotic lesions in the frontoparietal area. We report a case of LSCS in a woman who presented with progressive mild hyperchromia on the right side of her forehead, with dermal atrophy and hair and eyebrow loss. After the failure of conservative treatments, the patient responded dramatically to injection of autologous localized concentrated growth factor. After three treatments, the atrophy, stiffness, and angiotelectasis on the affected area had improved. No recurrence was detected 24 months after the last treatment. This is the first study describing the use of autologous concentrated growth factor injection to alleviate clinical symptoms of LSCS. This suggests that concentrated growth factor may be a treatment for LSCS in the clinic.
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Affiliation(s)
- Lei Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Shuying Lv
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China.,School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Wenjun Lin
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China.,School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Dingquan Yang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
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25
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McGaugh S, Kallis P, Benedetto AD, Thomas RM. Janus kinase inhibitors for treatment of morphea and systemic sclerosis: a literature review. Dermatol Ther 2022; 35:e15437. [DOI: 10.1111/dth.15437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Scott McGaugh
- Department of Dermatology College of Medicine, University of Florida Gainesville Florida U.S.A
| | - Penelope Kallis
- Department of Dermatology College of Medicine, University of Florida Gainesville Florida U.S.A
| | - Anna De Benedetto
- Department of Dermatology University of Rochester Medical Center Rochester New York U.S.A
| | - Renee M. Thomas
- Department of Dermatology C. W. Bill Young Veterans Affairs Medical Center Bay Pines Florida U.S.A
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26
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Szczepanik-Kułak P, Michalak-Stoma A, Krasowska D. Usefulness of Dermoscopy in Localized Scleroderma (LoS, Morphea) Diagnosis and Assessment-Monocentric Cross-Sectional Study. J Clin Med 2022; 11:jcm11030764. [PMID: 35160216 PMCID: PMC8836985 DOI: 10.3390/jcm11030764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Abstract
Morphea, also known as localized scleroderma (LoS), is a chronic autoimmune disease of the connective tissue. The clinical picture of LoS distinguishes between active and inactive lesions. Sometimes the clinical findings are challenging to identify, and therefore, the need for additional methods is emphasized. Our study aimed to demonstrate the characteristic dermoscopic features in morphea skin lesions, focusing on demonstrating features in active and inactive lesions. In our patients (n = 31) with histopathologically proven LoS, we performed clinical evaluation of lesions (n = 162): active/inactive and according to both disease activity (modified localized scleroderma severity index, mLoSSI) and damage (localized scleroderma skin damage index, LoSDI) parameters. In addition, we took into account compression locations to determine whether skin trauma, a known etiopathogenetic factor in LoS, affects the dermoscopic pattern of the lesions. We performed a dermoscopy of the lesions, categorizing the images according to the severity within the observed field. We showed that within the active lesions (clinically and with high mLoSSI), white clouds and linear branching vessels had the highest severity. These features decreased within the observed field in inactive lesions and with high LoSDI. Brownish structureless areas were most intense in inactive lesions with high LoSDI. Erythematous areas, linear branching vessels, dotted vessels, and crystalline structures were statistically significant for pressure locations. We have shown dermoscopy is a valuable tool to assess the activity or inactivity of lesions, which translates into appropriate therapeutic decisions and the possibility of monitoring the patient during and after therapy for possible relapse.
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27
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Tapdia MR, Favas TT, Mishra VN, Pathak A, Singh VK. Generalized Morphea Coincident With Aplastic Anemia: A Case Report. Cureus 2022; 14:e20955. [PMID: 35154935 PMCID: PMC8815815 DOI: 10.7759/cureus.20955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
Abstract
Morphea is a rare skin condition characterized by erythematous or violaceous lesions as well as sclerotic plaques. Patients with morphea frequently have other autoimmune disorders. Contributing factors are thought to be autoimmunity and an increase in extracellular matrix production. A case of a 45-year-old male patient with progressive restriction of both shoulder movements and patchy discoloration over the abdomen, neck, back, forearms, and bilateral axillae is discussed in this article. Examination revealed multiple shiny hyperpigmented to hypopigmented indurated plaques, and some lesions showed erythematous to violaceous borders, fine scales, and woody induration. The neurological examination was normal. Skin biopsy showed a sparse superficial perivascular lymphohistiocytic infiltrate with thickening of collagen bundles that were hyalinized in the reticular dermis, which was consistent with superficial morphea. Hematological tests showed pancytopenia and bone marrow aspiration revealed hypocellular marrow, which was consistent with aplastic anemia. The patient was diagnosed with generalized morphea with aplastic anemia. The patient was referred to a transplant center for further treatment, but, unfortunately, he died of sepsis while waiting for his transplant. Our case may indicate a possible link between aplastic anemia and generalized morphea. Due to a possible similar underlying mechanism of pathogenesis, treatment of aplastic anemia may be effective in morphea also. Aplastic anemia must be detected early to reduce complications and mortality in patients.
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28
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Hashimoto H, Nakahara T. Small-sized shiny sclerotic plaques: Think early morphea. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221105130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Morphea is a rare fibrosing disorder of the skin and underlying tissues. To date, the size of morphea has not been adequately discussed. Here, we report two cases of small-sized superficial circumscribed morphea. Both cases clinically revealed single circumscribed, round to oval area of shiny sclerotic plaque at distal extremities. There are several options for the treatment of superficial circumscribed morphea, such as topical corticosteroid and phototherapy. The early recognition of small-sized morphea enables appropriate diagnosis and follow-up, leading to improve disease prognosis.
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Affiliation(s)
- Hiroki Hashimoto
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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29
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Tognetti L, Marrocco C, Carraro A, Conticini E, Habougit C, Mariotti G, Cinotti E, Perrot JL, Rubegni P. UVA-1 phototherapy as adjuvant treatment for eosinophilic fasciitis: in vitro and in vivo functional characterization. Int J Dermatol 2021; 61:718-726. [PMID: 34881449 PMCID: PMC9299925 DOI: 10.1111/ijd.16003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Eosinophilic fasciitis (EF) is a rare autoimmune disease causing progressive induration of dermal, hypodermal, and muscularis fascia. The exact pathogenesis is yet to be fully understood, and a validated therapy protocol still lacks. We here aimed to realize a clinical-functional characterization of these patients. MATERIALS AND METHODS A total of eight patients (five males, 45 years average) were treated with adjuvant high-dose UVA-1 phototherapy (90 J/cm), after having received the standard systemic immunosuppressive protocol (oral methylprednisolone switched to methotrexate). Body lesion mapping, Localized Scleroderma Assessment Tool (LoSCAT), Dermatology Life Quality Index (DLQI), High-Resolution Ultrasound (HRUS) (13-17MHz), and ultra HRUS (55-70 MHz) were performed at each examination time taking specific anatomical points. Gene expression analysis at a molecular level and in vitro UVA-1 irradiation was realized on lesional fibroblasts primary cultures. RESULTS The LoSCAT and the DLQI showed to decrease significantly starting from the last UVA-1 session. A significant reduction in muscularis fascia thickness (-50% on average) was estimated starting from 3 months after the last UVA-1 session and maintained up to 12 months follow-up. Tissues was detected by HRUS. The UVA-1 in vitro irradiation of lesional skin sites cells appeared not to affect their viability. Molecular genes analysis revealed a significant reduction of IL-1ß and of TGF-ß genes after phototherapy, while MMPs 1,2,9 gene expression was enhanced. COMMENT These preliminary in vivo and in vitro findings suggest that UVA-1 phototherapy is a safe and useful adjuvant therapy able to elicit anti-inflammatory effects and stimulate tissue matrix digestion and remodeling at lesional sites.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Camilla Marrocco
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Andrea Carraro
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Cyril Habougit
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Giancarlo Mariotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
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Gutierrez D, Peterson EL, Kim RH, Franks AG, Lo Sicco KI. Eosinophilic Fasciitis With Concomitant Morphea Profunda Treated With Intravenous Immunoglobulin. J Clin Rheumatol 2021; 27:S500-S501. [PMID: 31693648 DOI: 10.1097/rhu.0000000000001158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Gutierrez
- The Ronald O. Perelman Department of Dermatology New York University School of Medicine New York, NY
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Dańczak-Pazdrowska A, Cieplewicz P, Żaba R, Adamski Z, Polańska A. Controversy around the morphea. Postepy Dermatol Alergol 2021; 38:716-720. [PMID: 34849114 PMCID: PMC8610066 DOI: 10.5114/ada.2021.106242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
Morphea, also known as localized scleroderma, is a chronic, autoimmune disease of connective tissue. It is characterized by a typical clinical feature. In morphea, there is no Raynaud's phenomenon, no sclerodactyly or no ulcerations on the fingertips. Although morphea and systemic sclerosis have been perceived as separate disease entities for years, they are still confused both by patients (which is a source of unnecessary stress) and doctors. This may be due to, in part, misunderstood terminology. The controversy around morphea also concerns the division of this disease entity, including its less common subtypes, such as eosinophilic fasciitis. Discussions also revolve around the diagnostic aspects and possible treatment options. The paper attempts to present the debatable aspects regarding nomenclature, classification, diagnosis and treatment of morphea.
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Affiliation(s)
| | - Paulina Cieplewicz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
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Marti-Marti I, Morgado-Carrasco D, Podlipnik S, Rizo-Potau D, Bosch-Amate X, Lledó GM, Suárez-Lledó M, Espinosa G, Martínez C, Mascaró JM, Giavedoni P. Usefulness of high-frequency ultrasonography in the evaluation and monitoring of sclerosing dermatoses: a cohort study. Clin Exp Dermatol 2021; 47:351-358. [PMID: 34431556 DOI: 10.1111/ced.14903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/17/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Monitoring of disease activity in sclerosing dermatoses (SD) can be challenging and tools to support clinical decision-making are lacking. AIM To analyse the impact of high-frequency ultrasonography (HFUS) on the clinical management of SD and to describe the US characteristics of disease activity. METHODS This was a cohort study of patients with various SD [morphoea, systemic sclerosis (SS) and chronic graft-versus-host disease (cGvHD)] who underwent HFUS between January 2017 and August 2019. HFUS criteria for diagnosing active SD were increased Doppler vascularity and/or meeting all B-mode greyscale US signs of activity. Discordance in SD activity between HFUS and clinical examination was evaluated at the time of the first US assessment. Changes in patient management were instituted after HFUS were recorded. RESULTS In total, 72 patients (31 with morphoea, 19 with SS and 22 with cGvHD), who underwent 163 HFUS sessions in total, were included. All HFUS-active morphoea lesions exhibited increased vascularity, and all HFUS-active SS exhibited dermal thickening and dermal hypoechogenicity. HFUS-active cGvHD displayed increased dermal thickness and loss of definition of the dermal-hypodermal junction, and there were signs of panniculitis in 80% of cases and of increased vascularity in 70%. Discordance in disease activity between clinical and HFUS evaluation was found in 17 (23.6%) patients. Changes in clinical management after HFUS were made for 14 (19.4%) patients: treatment discontinuation for 6 patients (42.9%), treatment initiation for 5 (35.7%), medication change for 2 (14.3%) and skin biopsy taken for 1 (7.1%). CONCLUSION HFUS seems an efficacious support tool in the monitoring of SD activity with a notable impact on clinical management. Further studies are warranted to evaluate the impact of HFUS-supported management changes on SD outcomes.
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Affiliation(s)
- I Marti-Marti
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - S Podlipnik
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Rizo-Potau
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - X Bosch-Amate
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - G M Lledó
- Autoimmune Diseases, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Suárez-Lledó
- Hematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - G Espinosa
- Autoimmune Diseases, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - C Martínez
- Hematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - J M Mascaró
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - P Giavedoni
- Deparments of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Laser Therapy for the Treatment of Morphea: A Systematic Review of Literature. J Clin Med 2021; 10:jcm10153409. [PMID: 34362192 PMCID: PMC8347526 DOI: 10.3390/jcm10153409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Morphea, also known as localized scleroderma (LoS), comprises a set of autoimmune sclerotic skin diseases. It is characterized by inflammation and limited thickening and induration of the skin; however, in some cases, deeper tissues might also be involved. Although morphea is not considered a life-threatening disease, the apparent cosmetic disfigurement, functional or psychosocial impairment affects multiple fields of patients’ quality of life. Therapy for LoS is often unsatisfactory with numerous treatments that have only limited effectiveness or considerable side effects. Due to the advances in the application of lasers and their possible beneficial effects, the aim of this study is to review the reported usage of laser in morphea. We present a systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, Web of Science, and Google Scholar databases. We identified a total of twenty relevant studies (MEDLINE n = 10, Cinahl n = 1, Central n = 0, Scopus n = 2, Web of Science n = 5, Google Scholar n = 2) using laser therapy for LoS. Eight studies were focused on the use of PDL, six on fractional lasers (CO2 and Er:YAG), four on excimer, and two on either alexandrite or Nd:YAG.
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Jindal R, Shirazi N, Chauhan P. Histopathology of morphea: Sensitivity of various named signs, a retrospective study. INDIAN J PATHOL MICR 2021; 63:600-603. [PMID: 33154313 DOI: 10.4103/ijpm.ijpm_67_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Morphea or localized scleroderma is characterized histopathologically by sclerosis, fibrosis, and atrophy of the skin and subcutaneous tissue. Various authors have named the characteristic findings seen in histopathology of morphea and have labeled them as specific signs, including line sign, cookie-cutter sign, and square biopsy sign. Besides, other findings mentioned include high eccrine glands and the presence of interstitial mucin. The present study was undertaken to assess the sensitivity of these tests in the histopathological diagnosis of morphea. Methods All cases clinically diagnosed and histopathologically reported as morphea in the last 3 years (September 2016 to August 2019) were included. The slides were reviewed by two independent investigators for the presence of line sign, cookie-cutter sign, square biopsy sign, high eccrine glands, and mucin. The sensitivity of these signs in accurately diagnosing morphea was assessed. Besides, specificity, positive predictive value, and negative predictive value of these signs were assessed using 40 random histopathology slides as controls. Results The highest sensitivity was of high eccrine glands (82.5%) followed by the presence of mucin in the dermis (77.5%). Cookie-cutter sign and square biopsy signs were seen in 70% and 62.5% patients, respectively. Line sign was least sensitive of all, seen in 45% of biopsy specimens, but was most specific (82.5%). Conclusion A fair number of biopsies of morphea displays the presence of high eccrine glands, mucin, cookie-cutter sign, square biopsy sign, and line sign. These signs thus can be of immense help to the dermatopathology trainees.
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Affiliation(s)
- Rashmi Jindal
- Department of Dermatology, Venereology, and Leprosy, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Nadia Shirazi
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Payal Chauhan
- Department of Dermatology, Venereology, and Leprosy, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand, India
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Belmesk L, Muntyanu A, Cantin E, AlHalees Z, Jack CS, Le M, Sasseville D, Iannattone L, Ben-Shoshan M, Litvinov IV, Netchiporouk E. Prominent Role of Type 2 Immunity in Skin Diseases-Beyond Atopic Dermatitis. J Cutan Med Surg 2021; 26:33-49. [PMID: 34261335 DOI: 10.1177/12034754211027858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Type 2 immunity, illustrated by T helper 2 lymphocytes (Th2) and downstream cytokines (IL-4, IL-13, IL-31) as well as group 2 innate lymphoid cells (ILC2), is important in host defense and wound healing.1 The hallmark of type 2 inflammation is eosinophilia and/or high IgE counts and is best recognized in atopic diathesis. Persistent eosinophilia, such as seen in hypereosinophilic syndromes, leads to fibrosis and hence therapeutic Type 2 inhibition in fibrotic diseases is of high interest. Furthermore, as demonstrated in cutaneous T cell lymphoma, advanced disease is characterized by Th1 to Th2 switch allowing cancer progression and immunosuppression. Development of targeted monoclonal antibodies against IL-4Rα (eg, dupilumab) led to a paradigm shift for the treatment of atopic dermatitis (AD) and stimulated research to better understand the role of Type 2 inflammation in other skin conditions. In this review, we summarize up to date knowledge on the role of Type 2 inflammation in skin diseases other than AD and highlight whether the use of Type 2 targeted therapies has been documented or is being investigated in clinical trials. This manuscript reviews the role of Type 2 inflammation in dermatitis, neurodermatitis, IgE-mediated dermatoses (eg, bullous pemphigoid, chronic spontaneous urticaria), sclerodermoid conditions and skin neoplasms.
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Affiliation(s)
| | - Anastasiya Muntyanu
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Zeinah AlHalees
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Carolyn S Jack
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Michelle Le
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Denis Sasseville
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Lisa Iannattone
- 60301 Division of Dermatology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Ivan V Litvinov
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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García-Vázquez A, Guillen-Climent S, Ramón Quiles M. RF - Generalized Morphea: Definition and Associations. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2019.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Korsten P. A "groovy" diagnosis: Eosinophilic fasciitis. Clin Case Rep 2020; 8:3545-3546. [PMID: 33363970 PMCID: PMC7752323 DOI: 10.1002/ccr3.3128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/24/2020] [Indexed: 12/04/2022] Open
Abstract
Clinical examination can be the key to pursuing a diagnosis, even in rare diseases. The "groove sign" is a typical finding in eosinophilic fasciitis and can be elicited by elevation of the arm to allow for venous return with visible "grooving" of the veins due to skin thickening.
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Affiliation(s)
- Peter Korsten
- Department of Nephrology and RheumatologyUniversity Medical Center GöttingenGöttingenGermany
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38
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García-Vázquez A, Guillen-Climent S, Ramón Quiles MD. RF - Generalized Morphea: Definition and Associations. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:366-367. [PMID: 33227275 DOI: 10.1016/j.ad.2019.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- A García-Vázquez
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - S Guillen-Climent
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - M D Ramón Quiles
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España
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Clinical characteristics and histopathologic changes of morphea: A single-center, retrospective study of 137 patients. J Am Acad Dermatol 2020; 85:105-113. [PMID: 33188871 DOI: 10.1016/j.jaad.2020.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The clinicopathologic correlations and prognostic risk factors for refractory disease in morphea (localized scleroderma) are poorly described. OBJECTIVE To investigate the association between clinical characteristics and histopathologic features of morphea and identify risk factors for refractory disease. METHODS We retrospectively reviewed the clinical and histopathologic features, treatment regimens, and clinical responses for 137 patients with biopsy-proven morphea from January 2008 to May 2019. Multivariate analysis was conducted to identify factors associated with poor treatment response. RESULTS We detected associations between the pattern and degree of sclerosis and the anatomic site of the lesion, as well as between severe inflammation and concomitant autoimmune disease. Additionally, both bottom-heavy sclerosis and increased inflammation were associated with functional limitations/clinical symptoms. Based on our multivariate analysis, we found that increased risk of poor treatment response was correlated with tissue eosinophils and basal pigmentation. LIMITATIONS This was a single-center retrospective study. CONCLUSION Skin biopsy samples could show specific features of morphea, including eosinophil infiltration and basal pigmentation, which may indicate the need for aggressive treatment and frequent monitoring.
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Scorer M, Mann J, Abid M. Deep morphoea with dystrophic calcification induced by cyclizine injections. Australas J Dermatol 2020; 61:373-374. [DOI: 10.1111/ajd.13335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/06/2020] [Accepted: 04/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew Scorer
- Department of Dermatology University Hospitals of Derby and Burton NHS Foundation Trust Derby UK
| | - Jasmine Mann
- Department of Dermatology University Hospitals of Derby and Burton NHS Foundation Trust Derby UK
| | - Maaz Abid
- Department of Dermatology University Hospitals of Derby and Burton NHS Foundation Trust Derby UK
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Dietze L, Metze D, Goerge T. Eosinophile Fasziitis – eine seltene Differenzialdiagnose bei venösen Symptomen. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1171-5047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEin 26-jähriger Sportler stellte sich in unserer phlebologischen Ambulanz zur Diagnostik und Therapie bei sichtbarer Varikosis am linken Bein vor. Sonografisch stellte sich eine insuffiziente Vena saphena magna links dar. Es wurde eine VNUS-Closure der VSM links komplikationslos durchgeführt. Trotz sonografisch unauffälligen Kontrollen berichtet der Patient im weiteren Verlauf über ein zunehmendes Schweregefühl und eine Verhärtung der Haut. In der Histologie konnte eine eosinophile Fasziitis nachgewiesen werden. Bisher gibt es keine Berichte zum Zusammenhang von chronisch-venöser Insuffizienz, der endoluminalen Behandlung und eosionphiler Fasziitis. Der Fallbericht stellt eine seltene, aber in diesem Fall wichtige Differenzialdiagnose bei postinterventionellen venösen Beschwerden dar.
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Lineare Sklerodermie „en coup de sabre“ mit neurologischer und okulärer Beteiligung. Hautarzt 2020; 71:802-804. [DOI: 10.1007/s00105-020-04621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yamamoto T, Ito T, Asano Y, Sato S, Motegi SI, Ishikawa O, Matsushita T, Takehara K, Makino T, Okiyama N, Fujimoto M, Jinnin M, Ihn H. Characteristics of Japanese patients with eosinophilic fasciitis: A brief multicenter study. J Dermatol 2020; 47:1391-1394. [PMID: 32860239 DOI: 10.1111/1346-8138.15561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Eosinophilic fasciitis is a relatively rare cutaneous fibrotic condition affecting the deep fascia of the extremities, with or without peripheral blood eosinophilia. To examine the characteristics of Japanese patients with eosinophilic fasciitis, we conducted a brief, multicenter, retrospective survey at seven university hospitals. In total, 31 patients were identified as having eosinophilic fasciitis, among whom 30 patients fulfilled the Japanese diagnostic criteria. The male : female ratio was 2.3:1, and the mean age was 47.7 years. Three of the patients were under 20 years old. The possible triggering factors included muscle training, sports, walking or sitting for a long time, physical work, insect bite and drug. Co-occurrence of morphea was observed in nine cases (29%), and malignancies were associated in three (two hematological malignancies and one internal malignancy). Immunological abnormalities in the serum showed positive antinuclear antibody, positive rheumatoid factor, increased aldolase levels and increased immunoglobulin G levels. The patients were treated with either monotherapy or combination therapy by oral prednisolone (20-80 mg/day), methotrexate (6-10 mg/week), cyclosporin (100-150 mg/day), mizoribine, infliximab and phototherapy. Methylprednisolone pulse therapy was performed in six cases. By contrast, spontaneous improvement due to resting only was observed in two cases, and skin hardening was improved by withdrawal of the anticancer drug in one case. This study suggests several characteristics of Japanese patients with eosinophilic fasciitis, namely male predominance, rare pediatric occurrence, immunological abnormalities and coexistence with morphea. Systemic prednisolone is the first-line therapy, but pulse therapy is occasionally required for severe cases. The triggering events of physical stress are not so frequent as have previously been reported, and various factors or even unknown factors may be associated with the induction of eosinophilic fasciitis.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Takashi Ito
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | | | - Osamu Ishikawa
- Department of Dermatology, Gunma University, Maebashi, Japan
| | | | | | | | - Naoko Okiyama
- Department of Dermatology, Tsukuba University, Tsukuba, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Tsukuba University, Tsukuba, Japan.,Department of Dermatology, Osaka University, Osaka, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Hironobu Ihn
- Department of Dermatology, Kumamoto University, Kumamoto, Japan
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Abstract
Eosinophilic dermatoses encompass a broad spectrum of diseases of different etiologies hallmarked by eosinophilic infiltration of the skin and/or mucous membranes, with or without associated blood eosinophilia. The wide range of dermatological manifestations of this spectrum, including nodules and plaques, pustules, blisters, ulcers, and urticarial lesions, is reflected in a non-univocal classification system. We identified six groups of eosinophilic dermatoses based on the predominant anatomic level of involvement: (1) epidermal; (2) of the dermal-epidermal junction; (3) dermal; (4) of the hypodermis and muscle fascia; (5) of the pilosebaceous unit; and (6) vascular/perivascular. We review clinicopathologic features and management of diseases belonging to each group, particularly: (1) pemphigus herpetiformis and atopic dermatitis as prototypes of the epidermal group; (2) bullous pemphigoid as prototypic eosinophilic dermatosis of the dermal-epidermal junction; (3) eosinophilic cellulitis (Wells syndrome), hypereosinophilic syndromes, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, eosinophilic dermatosis of hematologic malignancy and chronic spontaneous urticaria as paradigmatic dermal eosinophilic dermatoses; (4) eosinophilic fasciitis as an eosinophilic dermatosis with predominant involvement of the hypodermis and muscle fascia; (5) eosinophilic pustular folliculitis as a model of the pilosebaceous unit involvement; and (6) granuloma faciale, angiolymphoid hyperplasia with eosinophilia, and eosinophilic granulomatosis with polyangiitis, belonging to the vascular/perivascular group.
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Sapra A, Dix R, Bhandari P, Mohammed A, Ranjit E. A Case of Extensive Debilitating Generalized Morphea. Cureus 2020; 12:e8117. [PMID: 32542170 PMCID: PMC7292686 DOI: 10.7759/cureus.8117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Morphea, also known as localized scleroderma, is an uncommon idiopathic inflammatory disorder leading to the development of sclerotic plaques in the skin. The disorder preferentially affects females. The pathogenesis of morphea is not well-understood. The disorder is likely to have an autoimmune basis; environmental and genetic factors may also play a role in its etiology. Morphea has a variety of clinical presentations. Lesions of morphea typically begin as inflammatory plaques or patches that evolve into firm sclerotic lesions. Involvement may be limited to the dermis or may extend to underlying subcutaneous fat, muscle, or bone. The identification of characteristic clinical findings is often sufficient for the diagnosis of morphea. A biopsy can be a useful tool when the diagnosis is in question or to obtain information on the depth and intensity of the disease, and it should always extend at least into the subcutaneous fat. Morphea may cause joint contractures and other impairments secondary to tissue sclerosis and can be very debilitating cosmetically and functionally.
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Affiliation(s)
- Amit Sapra
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Rebecca Dix
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Priyanka Bhandari
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Asiya Mohammed
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Eukesh Ranjit
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
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Khatri AM, McLemore M, Malhotra P. Morphea (Localized Scleroderma) Presenting With Recurrent Skin and Soft Tissue Infections: A Diagnostic Dilemma. Cureus 2020; 12:e8067. [PMID: 32542124 PMCID: PMC7290118 DOI: 10.7759/cureus.8067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
Morphea or localized scleroderma is reported to be triggered through diverse stimuli. We present a case of morphea that presented as a non-healing wound with superimposed methicillin-sensitive Staphylococcus aureus (MSSA) infection. In our case, morphea was thought to have been potentially triggered by a post-surgical infection. We discuss the potential infectious triggers and common infections that may confound the diagnosis.
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Affiliation(s)
| | - Michael McLemore
- Dermatology, Pathology and Laboratory Medicine, Northwell Health, Manhasset, USA
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Creadore A, Watchmaker J, Maymone MBC, Pappas L, Lam C, Vashi NA. Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with morphea/systemic sclerosis. J Am Acad Dermatol 2020; 83:315-341. [PMID: 32360721 DOI: 10.1016/j.jaad.2019.12.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/06/2023]
Abstract
Morphea and systemic sclerosis are inflammatory, sclerosing disorders. Morphea primarily affects the dermis and subcutaneous fat, while systemic sclerosis typically involves the skin and internal organs. Functional impairment and cosmetic disfigurement are common in both diseases. Treatment options to mitigate disease progression remain limited. Both functional impairment and cosmetic deficits negatively impact quality of life and psychological well-being in this patient population. While the number of cosmetic procedures performed in the United States continues to rise each year, limited data exist regarding best practices for correcting aesthetic deficits caused by autoimmune conditions. There is scarce information to guide safety decisions regarding laser parameters, soft tissue augmentation, treatment intervals, and the concurrent use of immune-modifying or immune-suppressing medications. Given the fears of disease reactivation and exacerbation from postprocedural inflammation along with limited data, it is difficult for clinicians to provide evidence-based cosmetic treatment with realistic expectations with regard to short- and long-term outcomes. In the first article in this continuing medical education series, we attempt to address this practice gap.
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Affiliation(s)
| | - Jacqueline Watchmaker
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Leontios Pappas
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Christina Lam
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
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Sturdy A, Stratton R, Perez-Machado M, Lamb L. Case of eosinophilic fasciitis during military training in a Nepalese British infantry soldier. BMJ Mil Health 2020; 166:277-278. [PMID: 32139410 DOI: 10.1136/jramc-2019-001273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022]
Abstract
We present the case of a Nepalese British soldier with peripheral oedema and a significantly raised eosinophil count. After extensive investigation looking for a parasitic cause of his illness, he was diagnosed with eosinophilic fasciitis, a connective tissue disorder, often triggered by heavy exertion and responsiveness to immunosuppression. In a military setting, in which clinicians are likely to encounter patients who have spent time in tropical areas, it is important to still consider non-infectious causes of eosinophilia.
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Affiliation(s)
- Ann Sturdy
- Department of Infection, Royal Free Hospital, London, UK
| | - R Stratton
- Department of Rheumatology, Royal Free Hospital, London, UK
| | - M Perez-Machado
- Department of Cellular Pathology, Royal Free Hospital, London, UK
| | - L Lamb
- Department of Infection, Royal Free Hospital, London, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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50
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Orteu CH, Ong VH, Denton CP. Scleroderma mimics - Clinical features and management. Best Pract Res Clin Rheumatol 2020; 34:101489. [PMID: 32147386 DOI: 10.1016/j.berh.2020.101489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Systemic sclerosis is a severe immune-mediated rheumatic disease by virtue of its clinical impact and mortality. There are a number of other sclerosing skin diseases that should be considered in the differential diagnosis and these are important because they may require specialist investigation and management. In addition, long-term follow up of the different conditions should reflect the risk of associated complications and anticipated duration of therapy. This article reviews the clinical features of potential mimics of scleroderma (systemic sclerosis) including localised forms of scleroderma (morphoea) and other conditions that lead to skin thickening and connective tissue fibrosis or scarring.
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Affiliation(s)
- Catherine H Orteu
- Department of Dermatology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Voon H Ong
- Centre for Rheumatology, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK.
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