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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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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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Asano Y, Fujimoto M, Ishikawa O, Sato S, Jinnin M, Takehara K, Hasegawa M, Yamamoto T, Ihn H. Diagnostic criteria, severity classification and guidelines of localized scleroderma. J Dermatol 2018; 45:755-780. [PMID: 29687475 DOI: 10.1111/1346-8138.14161] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
We established diagnostic criteria and severity classification of localized scleroderma because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for localized scleroderma, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of localized scleroderma.
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Affiliation(s)
- Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Jamalpur I, Mogili HR, Koratala A. Disabling pansclerotic morphoea of childhood. BMJ Case Rep 2018; 2018:bcr-2017-222132. [PMID: 29455178 DOI: 10.1136/bcr-2017-222132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Disabling pansclerotic morphoea (DPM) of childhood is a severe and often fatal variant of deep morphoea. It usually starts in childhood and rarely seen in adults. The course of the disease is progressive with lifelong morbidity in the form of joint contractures and immobility. The causes of mortality include complications such as sepsis, gangrene and cardiopulmonary involvement. Herein, we discuss the case of a 15-year-old girl with limb deformity and finger contractures, that is, bone involvement. The diagnosis of DPM of childhood was fortuitously made after the correction of limb deformity, when the patient was seen in the dermatology department for evaluation of skin discolouration on the thighs.
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Affiliation(s)
- Indirakshi Jamalpur
- Department of Dermatology, Kurnool Medical College, Kurnool, Andhra Pradesh, India
| | - Harikrishna Reddy Mogili
- Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Abhilash Koratala
- Department of Nephrology, University of Florida College of Medicine, Gainesville, Florida, USA
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Ruiz-Matta JM, Flores-Bozo LR, Dominguez-Cherit J. Metastatic Squamous Cell Carcinoma in a Patient with Disabling Pansclerotic Morphea of Childhood. Pediatr Dermatol 2017; 34:e164-e167. [PMID: 28543434 DOI: 10.1111/pde.13160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disabling pansclerotic morphea of childhood (DPMC) is a rare disorder that confers a risk of developing ulcer-related squamous cell carcinoma (SCC). We describe a young man with long-standing DPMC and SCC with lung metastasis.
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Affiliation(s)
- Juan M Ruiz-Matta
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis R Flores-Bozo
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Judith Dominguez-Cherit
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Platsidaki E, Tzanetakou V, Kouris A, Stavropoulos PG. Methotrexate: an effective monotherapy for refractory generalized morphea. Clin Cosmet Investig Dermatol 2017; 10:165-169. [PMID: 28507446 PMCID: PMC5428760 DOI: 10.2147/ccid.s134879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Morphea is an inflammatory skin disorder characterized by excessive collagen deposition. Although treatment algorithms for morphea subtypes have been suggested, no consistent recommendations are available. This study attempts to evaluate the clinical efficacy of methotrexate (MTX) as monotherapy in refractory generalized morphea. Methods It is a retrospective study, including 20 patients who had already been treated with various topical and systemic therapies with minimal clinical improvement. Patients received orally MTX at a of dosage 15 mg once weekly. Duration of the use, dosage of MTX, and adverse events were recorded. Clinical assessment of skin lesions was performed and documented. Results The mean disease duration was 27 months before the initiation of MTX treatment. After 12 months of therapy, very good response was achieved in 6 patients (30%), good response in 10 patients (50%), and fair response in 2 patients (10%), while 2 patients (10%) had failed treatment. Patients were followed up for a mean time interval of 21 months. No serious adverse event was recorded. Conclusion MTX has been already proved to be an effective and well-tolerated treatment in pediatric patients with morphea. The majority of the group of adult patients showed very good and good improvement when treated with MTX. Although this is an uncontrolled study, MTX monotherapy was considered a safe and effective treatment for the management of this specific clinical subset of morphea in adults.
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Affiliation(s)
- Eftychia Platsidaki
- Department of Dermatology and Venereology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - Vassiliki Tzanetakou
- Department of Dermatology and Venereology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - Anargyros Kouris
- Department of Dermatology and Venereology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - Panagiotis G Stavropoulos
- Department of Dermatology and Venereology, Andreas Syggros Hospital, University of Athens, Athens, Greece
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Updated recommendations on the use of hydroxychloroquine in dermatologic practice. J Am Acad Dermatol 2017; 76:1176-1182. [PMID: 28318681 DOI: 10.1016/j.jaad.2017.01.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 12/27/2022]
Abstract
Hydroxychloroquine has unique immunomodulatory properties and an attractive adverse effect profile. Over the past 10 years, research has led to significant updates in clinical recommendations concerning the optimal use of hydroxychloroquine and monitoring of patients taking it. We discuss updated recommendations concerning hydroxychloroquine daily dosing, retinopathy screening, serologic monitoring, use in smokers, use in pregnant women, and adverse effect risk and monitoring. This review can hopefully serve as an aid to dermatologists and help ensure they continue using hydroxychloroquine safely and effectively.
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Abstract
Cutaneous fibrosing disorders encompass a diverse array of diseases united by the presence of varying degrees of dermal sclerosis. The quality and distribution of skin involvement, presence or absence of systemic complications and unique associated laboratory abnormalities often help to distinguish between these diseases. It is imperative that an effort is made to accurately differentiate between scleroderma and its mimics, in order to guide long-term management and facilitate implementation of the appropriate treatment modality where indicated.
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Gorkiewicz-Petkow A, Kalinska-Bienias A. Systemic involvement in localized scleroderma/morphea. Clin Dermatol 2015; 33:556-62. [DOI: 10.1016/j.clindermatol.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hong JH, Kim JE, Ko JY, Ro YS. A clinicopathologic study of morphea in Korean patients. J Cutan Pathol 2015; 42:929-936. [DOI: 10.1111/cup.12528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/13/2014] [Accepted: 02/03/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Jeong Ho Hong
- Department of Dermatology; Hanyang University College of Medicine; Seoul Korea
| | - Jeong Eun Kim
- Department of Dermatology; Hanyang University College of Medicine; Seoul Korea
| | - Joo Yeon Ko
- Department of Dermatology; Hanyang University College of Medicine; Seoul Korea
| | - Young Suck Ro
- Department of Dermatology; Hanyang University College of Medicine; Seoul Korea
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Grewal I, Khan O, Davis W. Squamous cell carcinoma and eosinophilia in a long-term course of pansclerotic morphea. BMJ Case Rep 2014; 2014:bcr-2014-205737. [PMID: 25312894 DOI: 10.1136/bcr-2014-205737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pansclerotic morphea is a rare subtype of localised scleroderma. Very few cases have been reported in the literature. This case discusses a young man with a 15-year history of pansclerotic morphea, illustrating the clinical course and complications of this disease. Notably, recurrent squamous cell carcinomas with several high-risk features and frequent cellulitis were the basis of many admissions. As often seen with this disease, autoimmune markers were negative. However, marked eosinophilia was noted late in the course. Furthermore, this disease is quite resistant to treatment. Immunosuppressive therapy thus far has perhaps slowed the progression, although not cured the disease in this patient.
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Affiliation(s)
| | - Omar Khan
- Department of Rheumatology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - William Davis
- Department of Rheumatology, Ochsner Medical Center, New Orleans, Louisiana, USA
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Odhav A, Hoeltzel MF, Canty K. Pansclerotic morphea with features of eosinophilic fasciitis: distinct entities or part of a continuum? Pediatr Dermatol 2014; 31:e42-7. [PMID: 24383741 DOI: 10.1111/pde.12279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Scleroderma is a highly complex disorder in its clinical manifestations and pathogenesis. It has a wide range of clinical manifestations due to varying degrees of vasculopathy, autoimmunity, altered endothelium function, and abnormal fibrosis. The most widely used classification system grouped eosinophilic fasciitis and disabling pansclerotic morphea of childhood into the category of deep morphea. This previous classification does not include a category for overlapping conditions. A proposed new classification includes a new mixed subtype in which a combination of two or more of the previous subtypes is present in the same individual, although eosinophilic fasciitis has been excluded. We present the case of a 4-year-old boy who presented with features of disabling pansclerotic morphea and eosinophilic fasciitis simultaneously, which to our knowledge has not been previously reported. This suggests that these diseases are part of a more closely related continuum rather than separate disorders, as currently classified.
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Affiliation(s)
- Ashika Odhav
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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Kim A, Marinkovich N, Vasquez R, Jacobe HT. Clinical features of patients with morphea and the pansclerotic subtype: a cross-sectional study from the morphea in adults and children cohort. J Rheumatol 2013; 41:106-12. [PMID: 24293577 DOI: 10.3899/jrheum.130029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pansclerotic morphea is a poorly described form of morphea with little information on prevalence, demographics, and clinical features. Classification criteria for this subtype varies and the distinction from other forms of morphea, such as extensive generalized morphea and pansclerotic morphea, is not always clear. The purpose of our study was to clarify classification criteria for pansclerotic morphea by identifying its prevalence in the morphea in adults and children (MAC) cohort and describing its demographic and clinical features as compared with generalized morphea. METHODS Patients who met predefined criteria for generalized and pansclerotic morphea were identified using a modified Laxer and Zulian classification system. Baseline demographic and clinical features of the patients were compiled and then analyzed for traits characteristic of pansclerotic morphea versus those of generalized morphea. One hundred and thirteen patients met the criteria for inclusion: pansclerotic (n = 13) and generalized morphea type (n = 100). RESULTS Patients with pansclerotic morphea were more frequently male (46.2% vs 6%; p < 0.0001); had a shorter time to diagnosis (mean difference of 10.4 mos; 95% CI: 0.8-19.9 mos; p = 0.0332); higher rates of functional impairment (61.5% vs 16%; p = 0.0046); higher rates of deep involvement (61.5% vs 17%; p = 0.004); and higher average Rodnan Skin Score (mean difference of 10.8 points; 95% CI: 5-16.6; p = 0.0017), Localized Scleroderma Skin Damage Index (mean difference 28.3; 95% CI: 9-47.6; p = 0.009), and Physician Global Assessment of Disease Damage scores (mean difference 25.1; 95% CI: 0.3-50; p = 0.048). CONCLUSION Our results suggest demographic and clinical features are sufficient to define the pansclerotic subtype as they represent a distinct clinical phenotype with a more rapidly progressive and severe course commonly accompanied by disability. Presence of features of the pansclerotic phenotype should alert practitioners to the possibility of significant morbidity and the need for early aggressive treatment.
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Affiliation(s)
- Andrew Kim
- From the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Dermatology, Washington Hospital Center, Washington, DC, USA
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Bielsa Marsol I. Actualización en la clasificación y el tratamiento de la esclerodermia localizada. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Bielsa Marsol I. Update on the classification and treatment of localized scleroderma. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:654-66. [PMID: 23948159 DOI: 10.1016/j.adengl.2012.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/07/2012] [Indexed: 01/26/2023] Open
Abstract
Morphea or localized scleroderma is a distinctive inflammatory disease that leads to sclerosis of the skin and subcutaneous tissues. It comprises a number of subtypes differentiated according to their clinical presentation and the structure of the skin and underlying tissues involved in the fibrotic process. However, classification is difficult because the boundaries between the different types of morphea are blurred and different entities frequently overlap. The main subtypes are plaque morphea, linear scleroderma, generalized morphea, and pansclerotic morphea. With certain exceptions, the disorder does not have serious systemic repercussions, but it can cause considerable morbidity. In the case of lesions affecting the head, neurological and ocular complications may occur. There is no really effective and universal treatment so it is important to make a correct assessment of the extent and severity of the disease before deciding on a treatment approach.
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Affiliation(s)
- I Bielsa Marsol
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain.
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A systematic review of morphea treatments and therapeutic algorithm. J Am Acad Dermatol 2011; 65:925-41. [DOI: 10.1016/j.jaad.2010.09.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/27/2010] [Accepted: 09/09/2010] [Indexed: 11/23/2022]
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Cutaneous squamous cell carcinoma arising within generalised morphea. J Plast Reconstr Aesthet Surg 2011; 64:e149-52. [DOI: 10.1016/j.bjps.2011.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/23/2011] [Accepted: 01/26/2011] [Indexed: 01/23/2023]
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Fett N, Werth VP. Update on morphea. J Am Acad Dermatol 2011; 64:217-28; quiz 229-30. [PMID: 21238823 DOI: 10.1016/j.jaad.2010.05.045] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/17/2010] [Accepted: 05/25/2010] [Indexed: 01/26/2023]
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Tekin NS, Altinyazar HC, Tekin IO, Keskin SI, Kucukoglu R, Onsun N. Disabling pansclerotic morphoea: a case report. Int J Clin Pract 2010; 64:99-101. [PMID: 20089019 DOI: 10.1111/j.1742-1241.2006.01039.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND A previously healthy 50-year-old man presented with thickening and hardening of the skin on his trunk, neck and upper extremities that had started after the appearance of a 5 cm web-like patch of blood vessels on his upper chest and progressed over 4 months. He also reported difficulties with swallowing and a 20 kg weight loss. INVESTIGATIONS Physical examination, laboratory testing, including complete blood count, autoimmune serology for antiplatelet, antinuclear and extractable nuclear antibodies, direct antiglobulin test, incisional skin biopsy, bone-marrow biopsy, and MRI of the upper extremities. DIAGNOSIS Pansclerotic morphea associated with red cell aplasia and immune-mediated thrombocytopenia. MANAGEMENT Treatment with prednisone 60 mg per day and methotrexate 15 mg per week was started, but symptoms worsened. Methotrexate was replaced by pulsed intravenous methylprednisolone (1 g daily for 3 days), followed by mycophenolate mofetil started at 1 g per day and titrated up over 4 weeks to 3 g per day. Severe bicytopenia developed that did not improve with an 8-week washout of immunosuppressive agents. His fibrotic skin and hematologic conditions dramatically responded to antithymocyte globulin 40 mg/kg daily for 4 days, plus 10 mg/kg ciclosporin and methylprednisolone 1 mg/kg per day.
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Marasini B, Conciato L, Belloli L, Massarotti M. Systemic Sclerosis and Cancer. Int J Immunopathol Pharmacol 2009; 22:573-8. [DOI: 10.1177/039463200902200303] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To review recent advances and current controversies on the association between systemic sclerosis (SSc) and cancer, PUBMED was searched from 1966 to the present using the terms: systemic sclerosis, cancer, morphoea, sclerotic diseases. Malignancies, mainly in lung and breast, coexist with idiopathic SSc or with SSc-like disorders, but not with localized forms of scleroderma (morphoea), with the exception of squamous cell carcinoma in patients with pansclerotic morphoea and skin ulcers. The mechanisms connecting SSc and malignancies are unknown. The occurrence of different cancer types with SSc or SSc-like disorders suggest different underlying mechanisms, including altered immune response, common genetic and environmental links, disease-dependent factors, tumor-derived biologic substances and therapies. The process of sclerosis itself may favour cancer in certain sites, and a reaction between T cells and neoantigens formed during irradiation has been suggested to explain the frequent development of morphoea after breast irradiation. Radiotherapy, especially when used for breast cancer, may trigger idiopathic SSc or morphoea and influence the severity of preexisting SSc, with the consequence that SSc is considered a relative contraindication to breast radiotherapy. In conclusion, cancer and SSc may be associated, but it is still controversial as to whether there is a causal relationship. Continuing interest in these associations, in particular in the different modalities of associations, may help to understand the underlying biological mechanisms and to identify patients at risk.
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Affiliation(s)
- B. Marasini
- Rheumatology Unit, IRCCS Istituto Clinico Humanitas, University of Milan, Milan, Italy
| | - L. Conciato
- Rheumatology Unit, IRCCS Istituto Clinico Humanitas, University of Milan, Milan, Italy
| | - L. Belloli
- Rheumatology Unit, IRCCS Istituto Clinico Humanitas, University of Milan, Milan, Italy
| | - M. Massarotti
- Rheumatology Unit, IRCCS Istituto Clinico Humanitas, University of Milan, Milan, Italy
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Zancanaro PCQ, Isaac AR, Garcia LT, Costa IMC. Esclerodermia localizada na criança: aspectos clínicos, diagnósticos e terapêuticos. An Bras Dermatol 2009; 84:161-72. [DOI: 10.1590/s0365-05962009000200009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A esclerodermia localizada, ou morféia, acomete crianças em idade escolar e, em geral, é autolimitada, apesar de localmente desfiguradora. A literatura descreve inúmeros fatores etiopatogênicos, bem como modalidades de investigação e tratamento. Este artigo reúne os estudos mais recentes e discute sua aplicação clínica.
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Petrov I, Gantcheva M, Miteva L, Vassileva S, Pramatarov K. Lower lip squamous cell carcinoma in disabling pansclerotic morphea of childhood. Pediatr Dermatol 2009; 26:59-61. [PMID: 19250408 DOI: 10.1111/j.1525-1470.2008.00823.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Disabling pansclerotic morphea of childhood (DPMC) is an aggressive form of cutaneous scleroderma that involves all layers of the skin, extending through the dermis and subcutaneous tissues to involve muscle, tendon, and even bone. As DPMC is extremely rare, its association with skin squamous cell carcinoma (SCC) is rarer still. To our knowledge there are only two cases of SCC in patients with DPMC that developed within areas of chronic skin ulceration. We report the first case of lower lip squamous cell carcinoma arising in a young woman with DPMC and discuss the carcinogenic pathway that may have led to its occurrence.
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Affiliation(s)
- Ivaylo Petrov
- Department of Dermatology, Medical University of Sofia, Bulgaria.
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Abstract
PURPOSE OF REVIEW Localized scleroderma, also known as morphea, is the most frequent form of scleroderma in childhood. Early diagnosis, appropriate assessment and effective treatment may improve the long-term outcome. RECENT FINDINGS Recent studies, regarding the microchimerism theory or the mechanism of action of phototherapy, have yielded important information on the disease etiopathogenesis. Others have added interesting contributions on new outcome measures for the disease assessment and for the development of future therapeutic trials. Previous results, using methotrexate and phototherapy, have been confirmed. A successful use of bosentan, an endothelin receptor antagonist with vasodilatative and antifibrotic properties for refractory cutaneous ulcerations in pansclerotic morphea, opens new horizons of treatment. SUMMARY Studies over the past year highlight the role of some outcome measures in the disease assessment and monitoring, with important implications both for the clinical practice and future clinical trials.
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Taïeb A, Constans J, Mahon FX. Une nouvelle piste thérapeutique pour les sclérodermies graves: le mésylate d’imatinib. Rev Med Interne 2008; 29:173-5. [PMID: 17597261 DOI: 10.1016/j.revmed.2007.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 05/21/2007] [Indexed: 12/26/2022]
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Zulian F. Systemic Sclerosis and Localized Scleroderma in Childhood. Rheum Dis Clin North Am 2008; 34:239-55; ix. [DOI: 10.1016/j.rdc.2007.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Deep morphea encompasses a variety of clinical entities in which inflammation and sclerosis are found in the deep dermis, panniculus, fascia, or superficial muscle. Morphea profunda, eosinophilic fasciitis, and disabling pansclerotic morphea of children are included in this group, but overlapping of the extent and depth of cutaneous involvement in these various conditions precludes their distinction on the sole basis of clinical or even histologic examination. Furthermore, the limits between morphea profunda and generalized morphea, which usually are classified outside this group, are not clear. Histologically, all these disorders show similar inflammatory and sclerotic findings, the primary difference being the depth of these changes. Associated clinical findings, including arthralgias, arthritis, contractures, or carpal tunnel syndrome, are frequent. Although visceral complications are uncommon, pulmonary, esophageal, and even cardiac abnormalities have been reported. Eosinophilia, hypergammaglobulinemia, and increased erythrocyte sedimentation rate may be present with disease activity. Laboratory studies may demonstrate autoantibody production. Treatment is nonstandardized but UVA irradiation and antiinflammatory or immunosuppressive drugs (mainly antimalarial agents and corticosteroids) may be beneficial.
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Affiliation(s)
- Isabel Bielsa
- Department of Dermatology, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Barcelona, Spain.
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Abstract
PURPOSE OF REVIEW Localized scleroderma, also known as morphoea, has a variety of clinical manifestations that can include systemic involvement. Early recognition, diagnosis and treatment may improve the long-term outcome. RECENT FINDINGS A large multicentre study coordinated by the Pediatric Rheumatology European Society has yielded important information on the epidemiology and clinical manifestations of juvenile localized scleroderma, especially as it pertains to systemic manifestations. Previous results using methotrexate and corticosteroids have been confirmed. Studies on phototherapy have also demonstrated efficacy. A new immunomodulator, imiquimod, has shown promise in an initial case series. SUMMARY Studies over the past year highlight the wide range of extracutaneous manifestations and different forms of localized scleroderma and suggest that treatment may be beneficial.
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Affiliation(s)
- Ronald M Laxer
- Department of Paediatrics and Medicine, University of Toronto, Vice President, Education and Quality, The Hospital for Sick Children, Toronto, Canada.
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