1
|
Del Papa J, Pucchio AC, Schneider M, Wang A. Perineural Inflammation as a Novel Feature in Lichen Sclerosus: A Case Series of Histologic and Clinical Features. Am J Dermatopathol 2024; 46:287-291. [PMID: 38457688 DOI: 10.1097/dad.0000000000002640] [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: 03/10/2024]
Abstract
ABSTRACT Lichen sclerosus (LS) is a frequently encountered inflammatory skin disorder characterized by whitened, atrophic patches that can cause pain and pruritus. The underlying cause of this condition remains unknown. Primarily affecting the genital area, this condition carries an increased risk of developing cutaneous cancers and frequently co-occurs with autoimmune disorders. Our retrospective study aimed to explore histologic features of LS, with a particular focus on a newly established finding and its potential implications. We examined 53 histologic cases of LS collected over 2 years. Experienced pathologists evaluated and reached a consensus on the assignment of histologic features. Patient charts were manually reviewed to gather relevant demographic and clinical data. Statistical analysis was performed using IBM SPSS Statistics (2021). Of the 53 total patients identified as meeting criteria for inclusion in this study, only 8 (15%) were male. Eight cases (15%) demonstrated perineural inflammatory infiltrate. Notably, half of all samples from male patients exhibited perineural inflammatory infiltrate. A statistically significant increase ( P < 0.01) in the presence of dermal plasma cells was identified in cases with perineural inflammation versus cases without this feature. The findings of our study highlight the recurrent nature of perineural inflammation in LS, providing valuable insights into this condition. Furthermore, we observed a notable correlation between perineural inflammation, male patients, and the presence of dermal plasma cells. These discoveries contribute to a better understanding of the underlying mechanisms of LS and suggest avenues for future research into the condition.
Collapse
Affiliation(s)
- Joshua Del Papa
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Aine Celestina Pucchio
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Mark Schneider
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
| | - Ami Wang
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
| |
Collapse
|
2
|
Gerritzen N, Ziob J, Brossart P, Schäfer VS. [Imaging of eosinophilic fasciitis in ultrasound and MRI (magnetic resonance imaging): a case report]. Z Rheumatol 2024; 83:134-138. [PMID: 35575828 PMCID: PMC10902094 DOI: 10.1007/s00393-022-01207-3] [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] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Eosinophilic fasciitis (EF, also known as Shulman syndrome) is an uncommon connective tissue disease characterized by inflammatory thickening of the fasciae as well as swelling and hardening of the skin. It mostly affects the lower extremities. Swollen and indurated skin, together with the groove sign, are typical clinical signs. So far, biopsy evidence of inflammation and thickening of the fascia has been the gold standard for diagnosis. Magnetic resonance imaging (MRI) is mentioned in the literature as an alternative method for confirming the diagnosis. We present a case of asymmetric EF in a 54-year-old German male. He came with painful induration of the right forearm, with a characteristic groove sign and limitation of motion of the right hand. The blood count revealed eosinophilia with 0.57 G/l or 9.6% (normal: 0.05-0.5 G/l and 0.5-5.5%), ANA and ENA were negative. The diagnosis was confirmed histologically and we were able to detect a thickened fascia in MRI and ultrasound imaging. The EF also appeared in the left lateral malleolus during the course of the illness. Treatment was carried out with prednisolone and methotrexate.
Collapse
Affiliation(s)
- Nicolas Gerritzen
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Jana Ziob
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Peter Brossart
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Valentin S Schäfer
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| |
Collapse
|
3
|
Speidel J, Hunzelmann N, Moinzadeh P. Sklerodermie – „die harte
Haut“. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1887-5399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungUnter dem Begriff Sklerodermie ist eine heterogene Gruppe von Erkrankungen
zusammengefasst, die eine kutane Sklerose gemeinsam haben. Die einzelnen
Erkrankungen variieren in der Beteiligung betroffener Strukturen wie Haut,
Fettgewebe, Muskulatur, Gelenkstrukturen, Knochen, innerer Organe und der damit
einhergehenden Krankheitsausprägung. Es lassen sich
grundsätzlich zwei verschiedene Subtypen unterscheiden: die lokalisierte
Sklerodermie (LoS) und die systemische Sklerose (SSc), die sich jeweils in
weitere Subgruppen unterteilen lassen. Es handelt sich um zwei verschiedene
Erkrankungen, die sich in der Ausprägung der Hautsklerosierung, der
Beteiligung innerer Organe, im Antikörper-Profil, im
Krankheitsmanagement sowie der Prognose unterscheiden. Darüber hinaus
gibt es Krankheitsbilder, die eine Sklerodermie imitieren und daher als
sklerodermie-artige Erkrankungen oder auch als Pseudosklerodermien bezeichnet
werden. Um die richtige Diagnose stellen zu können, ist ein
standardisiertes diagnostisches Vorgehen bedeutsam. Die frühe
Diagnosestellung ist wichtig, um frühzeitige eine Therapie einleiten zu
können, und so funktionelle kutane und extrakutane
Einschränkungen und auch kosmetische Schäden gering halten zu
können.
Collapse
Affiliation(s)
- Jil Speidel
- Uniklinik Köln, Klinik und Poliklinik für Dermatologie
und Venerologie, Köln
| | - Nicolas Hunzelmann
- Uniklinik Köln, Klinik und Poliklinik für Dermatologie
und Venerologie, Köln
| | - Pia Moinzadeh
- Uniklinik Köln, Klinik und Poliklinik für Dermatologie
und Venerologie, Köln
| |
Collapse
|
4
|
Cassisa A, Vannucchi M. Morphea Profunda with Tertiary Lymphoid Follicles: Description of Two Cases and Review of the Literature. Dermatopathology (Basel) 2022; 9:17-22. [PMID: 35076471 PMCID: PMC8788542 DOI: 10.3390/dermatopathology9010003] [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: 11/11/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
Morphea profunda or subcutaneous (deep) morphea is a variant of localized morphea, characterized by one or more ill-defined, deep sclerotic plaque. Preferential sites are the abdomen, trunk, sacral area, or extremities. The presence of hyperplastic lymphoid follicles in the context of the sclerotic bands of morphea is rarely described. Localized scleroderma is sustained by a profibrotic inflammatory profile. Transforming growth factor-β (TGF-β), an imbalance between functional subclasses of T-lymphocytes (innate immune cells) has a role in activate collagen deposition. In this case report, we present two cases of morphea profunda with lymphoid follicular hyperplasia. A systematic review of the literature on the pathophysiology of localized scleroderma is also presented, with particular reference to the presence of lymphoid structures.
Collapse
Affiliation(s)
- Angelo Cassisa
- Section of Pathology, Department of Oncology, San Giovanni di Dio Hospital, USL Centro Toscana, 50143 Florence, Italy
- Correspondence:
| | - Margherita Vannucchi
- Section of Pathology, Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy;
| |
Collapse
|
5
|
Dharmadji HP, Suwarsa O, Sutedja E, Pangastuti M, Gunawan H, Makarti K. Erythema Induratum of Bazin Accompanied by Atrophy of the Subcutaneous Fat. Int Med Case Rep J 2021; 14:777-781. [PMID: 34815719 PMCID: PMC8604635 DOI: 10.2147/imcrj.s336088] [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: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
Erythema induratum of Bazin (EIB) is a predominantly lobular panniculitis with or without vasculitis due to Mycobacterium tuberculosis (MTB) infection. Atrophic scars may remain after EIB was healed. Rare cases of EIB showing sharp skin depression may mimic deep morphea and lupus profundus. A rare case of EIB was reported in a 35-year-old female with slightly tender erythematous-violaceous nodules and hyperpigmented depressed scars on both lower legs, resulting in asymmetrical lower leg shape. Histopathological examination showed lobular panniculitis without vasculitis and granulomatous inflammation consisted of caseous necrosis, epithelioid cells, and multinucleated giant cells. Polymerase chain reaction (PCR) from skin biopsy revealed deoxyribonucleic acid (DNA) of MTB. Tuberculin skin test (TST) was positive with a 20-mm induration, and nuclear 99mTc-ethambutol scintigraphy was positive for tuberculosis infection in one-third distal portion of the left lower leg. Clinical improvements were shown after 6 months of antituberculosis therapy. EIB must be considered in patient with erythematous-violaceous nodules on lower leg, especially in endemic areas of tuberculosis infection since diagnosis can be difficult and occasionally, deceptive.
Collapse
Affiliation(s)
- Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Miranti Pangastuti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kristina Makarti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| |
Collapse
|
6
|
Morita TCAB, Trés GFS, García MSC, Halpern I, Criado PR, de Carvalho JF. Panniculitides of particular interest to the rheumatologist. Adv Rheumatol 2019; 59:35. [DOI: 10.1186/s42358-019-0077-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 07/12/2019] [Indexed: 12/28/2022] Open
|
7
|
Somalanka S, Udo I, Nair H, Baikunje S. Pfeifer-Weber-Christian disease and successful treatment with mycophenolate mofetil: a case report. BMJ Case Rep 2019; 12:12/5/e229167. [PMID: 31122958 DOI: 10.1136/bcr-2018-229167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inflammatory conditions manifest with a broad spectrum of signs and symptoms. Panniculitis is such a condition affecting the subcutaneous fat and presents as tender erythematous nodules. It is also associated with a systemic response and has been described in the literature as early as in 1892 by Pfeifer and in the 1920s by Weber and Christian. We present an unusual case of a Caucasian man with recurrent febrile illness, systemic inflammatory response and renal dysfunction requiring acute high dependency care. The authors successfully treated him with an antiproliferative agent, mycophenolate mofetil, which resulted in preventing him from having further episodes.
Collapse
Affiliation(s)
- Subash Somalanka
- South West Thames Renal & Transplantation Unit and South West Thames Institute for Renal Research, Saint Helier Hospital, Carshalton, Surrey, UK
| | - Ini Udo
- General Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Hari Nair
- Renal Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
| | | |
Collapse
|
8
|
Li C, Zhang J, Wang W, Chen Y. Hydroxychloroquine combined with superficial X‐ray—A new therapeutic method in the treatment of morphea profunda. Dermatol Ther 2019; 32:e12896. [DOI: 10.1111/dth.12896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chao Li
- Graduate School, Guangdong Medical University Zhanjiang China
- Dermatology Department, Dermatology HospitalSouthern Medical University Guangzhou China
| | - Jiao Zhang
- Dermatology Department, Dermatology HospitalSouthern Medical University Guangzhou China
| | - Weijia Wang
- Dermatology Department, Dermatology HospitalSouthern Medical University Guangzhou China
| | - Yongfeng Chen
- Dermatology Department, Dermatology HospitalSouthern Medical University Guangzhou China
| |
Collapse
|
9
|
Treatment of morphea with hydroxychloroquine: A retrospective review of 84 patients at Mayo Clinic, 1996-2013. J Am Acad Dermatol 2019; 80:1658-1663. [PMID: 30703458 DOI: 10.1016/j.jaad.2019.01.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/11/2019] [Accepted: 01/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few studies support treating morphea (localized scleroderma) with hydroxychloroquine. OBJECTIVE To assess the efficacy of hydroxychloroquine treatment of morphea. METHODS We conducted a retrospective study of 84 patients who had morphea and were treated with hydroxychloroquine monotherapy for at least 6 months at our institution from 1996 through 2013. The median times to initial and maximal responses were assessed. RESULTS Of the 84 patients (median age at diagnosis, 29.5 years), 65 (77.4%) were female, 36 (42.9%) had a complete response to hydroxychloroquine, 32 (38.1%) had a partial response greater than 50%, 10 (11.9%) had a partial response less than or equal to 50%, and 6 (7.1%) had no response. The median time to initial response was 4 months, and the median time to maximal response was 12 months. Ten patients (11.9%) experienced adverse effects from hydroxychloroquine; the most common adverse effect was nausea (6 patients). LIMITATIONS Retrospective study. CONCLUSIONS Hydroxychloroquine is a valuable treatment for morphea because of its high response rate and low rate of adverse effects; however, prospective studies are needed to determine its true efficacy.
Collapse
|
10
|
Ferreli C, Gasparini G, Parodi A, Cozzani E, Rongioletti F, Atzori L. Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 53:306-336. [PMID: 28712039 DOI: 10.1007/s12016-017-8625-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Scleroderma refers to an autoimmune connective tissue fibrosing disease, including three different subsets: localized scleroderma, limited cutaneous systemic sclerosis, and diffuse cutaneous systemic sclerosis with divergent patterns of organ involvement, autoantibody profiles, management, and prognostic implications. Although systemic sclerosis is considered the disease prototype that causes cutaneous sclerosis, there are many other conditions that can mimic and be confused with SSc. They can be classified into immune-mediated/inflammatory, immune-mediated/inflammatory with abnormal deposit (mucinoses), genetic, drug-induced and toxic, metabolic, panniculitis/vascular, and (para)neoplastic disorders according to clinico-pathological and pathogenetic correlations. This article reviews the clinical presentation with emphasis on cutaneous disease, etiopathogenesis, diagnosis, and treatment options available for the different forms of scleroderma firstly and for scleroderma-like disorders, including scleromyxedema, scleredema, nephrogenic systemic fibrosis, eosinophilic fasciitis, chronic graft-versus-host disease, porphyria cutanea tarda, diabetic stiff-hand syndrome (diabetic cheiroartropathy), and other minor forms. This latter group of conditions, termed also scleroderma mimics, sclerodermiform diseases, or pseudosclerodermas, shares the common thread of skin thickening but presents with distinct cutaneous manifestations, skin histology, and systemic implications or disease associations, differentiating each entity from the others and from scleroderma. The lack of Raynaud's phenomenon, capillaroscopic abnormalities, or scleroderma-specific autoantibodies is also important diagnostic clues. As cutaneous involvement is the earliest, most frequent and characteristic manifestation of scleroderma and sclerodermoid disorders, dermatologists are often the first-line doctors who must be able to promptly recognize skin symptoms to provide the affected patient a correct diagnosis and appropriate management.
Collapse
Affiliation(s)
- Caterina Ferreli
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences, DISSAL, IRCSS-AOU S. Martino-IST, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, DISSAL, IRCSS-AOU S. Martino-IST, University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences, DISSAL, IRCSS-AOU S. Martino-IST, University of Genoa, Genoa, Italy
| | - Franco Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Atzori
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Bali G, Kárpáti S, Sárdy M, Brodszky V, Hidvégi B, Rencz F. Association between quality of life and clinical characteristics in patients with morphea. Qual Life Res 2018; 27:2525-2532. [DOI: 10.1007/s11136-018-1897-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/19/2022]
|
13
|
Onajin O, Wieland CN, Peters MS, Lohse CM, Lehman JS. Clinicopathologic and immunophenotypic features of eosinophilic fasciitis and morphea profunda: A comparative study of 27 cases. J Am Acad Dermatol 2018; 78:121-128. [DOI: 10.1016/j.jaad.2017.06.148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 11/16/2022]
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Early- and late-stage morphea subtypes with deep tissue involvement is treatable with Abatacept (Orencia). Semin Arthritis Rheum 2017; 46:775-781. [DOI: 10.1016/j.semarthrit.2016.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 11/21/2022]
|
16
|
Abstract
The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Polyarteritis nodosa and Behçet's disease are the conditions that are based in the subcutaneous septa with vasculitis. Predominantly-lobular panniculitides with no vasculitis include pancreatogenic panniculitis, the panniculitis of alpha-1-antitrypsin deficiency, panniculitis associated with lupus erythematosus and dermatomyositis, subcutaneous Sweet syndrome, eosinophilic panniculitis, factitial panniculitis, cold panniculitis, panniculitis following injections of corticosteroids, lipomembranous (ischemic) panniculitis; sclerema neonatorum and subcutaneous fat necrosis of the newborn, and Rosai-Dorfman disease of the subcutis. Erythema induratum and infectious panniculitis are vasculitic and lobulocentric conditions. This article reviews the histological features of these diseases.
Collapse
Affiliation(s)
- Mark R Wick
- Section of Dermatopathology,Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, USA.
| |
Collapse
|
17
|
Abstract
Localized scleroderma (LoS) comprises a heterogeneous spectrum of fibrotic diseases that primarily affect the skin with inflammation and skin thickening. The extent of skin involvement and manifestation at extra-cutaneous structures characterizes the specific subset. Fat tissue, fascia, and sometimes muscle, and bones might be involved, and in rare cases the central nervous or ocular system. A worldwide accepted classification system for LoS is still lacking. The latest guidelines have proposed a distinction of limited, generalized, linear, deep, and mixed types. The exact pathophysiology of LoS is not fully understood yet, but it is thought that an externally triggered release of pro-inflammatory cytokines leads to a dysregulation of the connective tissue metabolism. LoS is diagnosed according to typical clinical features. Further diagnostic procedures are helpful to characterize the subtype and to define the extent of inflammation and fibrosis. Due to the heterogeneity of LoS, therapeutic strategies should always be selected depending on the respective subtype. The stage of tissue inflammation and sclerosis has to be considered. Treatment options such as topical corticosteroids, calcipotriol, and calcineurin inhibitors as well as phototherapy are well established. In subsets with severe wide-spread skin manifestation and/or extra-cutaneous involvement, methotrexate monotherapy or a combination of methotrexate and systemic corticosteroids need to be considered. Physical treatment should always be added to the topical and systemic treatment to prevent significant disabilities due to LoS. This article provides an updated review on the epidemiology, pathophysiology, clinical classification and treatment options for patients suffering from LoS.
Collapse
|
18
|
Tomasini C. Cordoniform morphea: a clinicopathologic study of two cases presenting with the rope sign. J Cutan Pathol 2016; 43:613-622. [PMID: 26990496 DOI: 10.1111/cup.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/23/2016] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Morphea clinically presenting as cordoniform lesions has not been described previously in the literature. OBJECTIVE Our goal was to describe the clinicopathologic features of morphea presenting with cord-like cutaneous lesions. METHODS The clinical notes of 420 patients with a diagnosis of morphea seen during the previous 10 years were reviewed to identify any cases that had cordoniform lesions at presentation. RESULTS Two adult patients (one male and one female) were identified. Both patients presented with chronic, slightly burning, bilateral, erythematous, linear or curvilinear elevated cutaneous indurations on the lateral chest wall strikingly reminiscent interstitial granulomatous dermatitis with arthritis. Histopathologically, typical changes of deep morphea with a band-like involvement only of the lower part of the reticular dermis and the superficial hypodermis and a remarkable perineural arrangement of the lymphoplasmocytic infiltrate were observed. The presence of Borrelia in skin biopsy samples of both patients was shown by immunohistochemistry and focus floating microscopy. In one patient, the presence of Borrelia afzelii DNA in the cutaneous biopsy was shown by polymerase chain reaction. CONCLUSIONS Cordoniform morphea is an exceedingly unusual and previously undescribed clinicopathologic presentation of morphea where Borrelia infection may play a causal role.
Collapse
Affiliation(s)
- Carlo Tomasini
- Dermatopathology Section, Azienda Ospedaliera Città della Salute d della Scienza, Turin, Italy
| |
Collapse
|
19
|
|
20
|
|
21
|
Wong B, Piliouras P, Mortimore R, Zonta M, Tucker S. Lower limb linear morphoea in a pregnant woman with known Graves' disease and cytomegalovirus immunoglobulin M positivity. Australas J Dermatol 2014; 56:e96-8. [PMID: 24712973 DOI: 10.1111/ajd.12173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/23/2014] [Indexed: 11/28/2022]
Abstract
We report a case of linear morphoea in a 21-year-old woman with known Graves' disease who was also cytomegalovirus (CMV) IgM-positive and in her early first trimester of pregnancy. The histopathology showed hyalinisation of the dermis with perivascular superficial and deep lymphocytic infiltrates extending into the septae of the subcutis and impinging on adjacent lobules; there was also fibrosis of the subcutis. Magnetic resonance imaging showed T2 high intensity of the subcutaneous tissue and intermuscular planes of the thigh and leg. It is well known that morphoea can follow pregnancy and thyroid disease and that CMV is postulated to contribute in some patients. This case highlights a combination of risk factors for this disease that have not been reported collectively in the literature to our knowledge.
Collapse
Affiliation(s)
| | - Peter Piliouras
- Dermatology Department, Cairns Base Hospital, Cairns, Australia
| | - Rohan Mortimore
- Department of Anatomical Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark Zonta
- Townsville Hospital, Townsville, Australia
| | - Simon Tucker
- Dermatology Department, Cairns Base Hospital, Cairns, Australia
| |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Ashika Odhav
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | | | | |
Collapse
|
23
|
Taniguchi Y, Okazaki M, Kagawa T, Nakajima K, Nakajima H, Terada Y. Atypical generalized morphea-like scleroderma presenting deep sclerosis on the fingers. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
24
|
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
|
25
|
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.
Collapse
Affiliation(s)
- I Bielsa Marsol
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
26
|
Abstract
In connective tissue diseases, panniculitis can be the sole manifestation or can occur along with the underlying disease process. The best described forms of connective tissue panniculitis are lupus erythematosus panniculitis and lupus profundus, panniculitis associated with dermatomyositis, and morphea- and scleroderma-associated panniculitis. These processes cause significant morbidity, such as deep atrophic scars, cosmetic disfigurement, and psychiatric sequelae. Because the inflammation is located in the subcutaneous adipose layer, topical therapies may not penetrate enough to be effective, and systemic agents are required. Despite the large number of reported cases and therapies, recommendations for treatment are based largely on case series and expert opinion due to a lack of controlled therapeutic trials. All treatments are off-label in the United States. The lack of validated clinical outcome measures makes systematic and controlled studies difficult. Nonetheless, further investigation into the most effective therapies for these conditions is needed.
Collapse
Affiliation(s)
- Inbal Braunstein
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
27
|
The Man With Tight Legs: Answer. Am J Dermatopathol 2011. [DOI: 10.1097/dad.0b013e31821768be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Lamam Bennani Z, Boussofara L, Denguezli M, Ghariani N, Saidi W, Sriha B, Belajouza C, Nouira R. [Annular lipoatrophy of the ankles]. Ann Dermatol Venereol 2011; 138:512-5. [PMID: 21700074 DOI: 10.1016/j.annder.2011.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/29/2010] [Accepted: 01/27/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Annular lipoatrophy of the ankles (ALA) is an extremely rare form of localized lipoatrophy characterized by atrophy of subcutaneous fat. We report a case of annular atrophy of the ankles associated with a history of diabetes and Graves' disease. PATIENTS AND METHODS A 22-year-old woman with a history of Graves' disease and diabetes consulted for annular lesions of ankles which had appeared three years earlier. She had suddenly developed erythematous annular plaques on the right ankle. One week later, the plaques had evolved towards progressive atrophic bands involving the lower third of the legs. The overlying skin was normal and muscle involvement was absent. Laboratory studies revealed an antinuclear antibody (ANA) titre of 1/640 while a skin biopsy specimen showed diffuse lobular lymphohistiocytic panniculitis rich in lymphocytes and lipophages foam cells without any evidence of vasculitis. A direct immunofluorescence microscopy study was negative. Lipoatrophy was still present after six months of chloroquine treatment (300mg per day). DISCUSSION ALA is a rare and poorly understood condition. Based on the ten or so case reports in the literature, we attempted to define the clinical and histological profile of the disease as well as its course and its relationship with other forms of atrophic panniculitis. In particular, the onset of LAC in our patient presenting several autoimmune diseases underlines its close relationship to the condition described as "connective tissue panniculitis".
Collapse
Affiliation(s)
- Z Lamam Bennani
- Service de dermatologie, centre hospitalo-universitaire Farhat Hached, 4000 Sousse, Tunisie
| | | | | | | | | | | | | | | |
Collapse
|
29
|
KIM HS, CHOI YJ, PARK YM, KIM HO, LEE JY. Case of juvenile localized scleroderma with joint sclerosis and Sjögren’s syndrome in a child with precocious puberty. J Dermatol 2011; 38:1024-7. [DOI: 10.1111/j.1346-8138.2010.01191.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Atypical generalized morphea-like scleroderma presenting deep sclerosis on the fingers. Mod Rheumatol 2011; 21:232-4. [DOI: 10.1007/s10165-010-0374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/19/2010] [Indexed: 11/25/2022]
|
31
|
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: 231] [Impact Index Per Article: 17.8] [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]
|
32
|
|
33
|
Morphoea with Myositis: A Rare Association. Case Rep Rheumatol 2011; 2011:134705. [PMID: 22937437 PMCID: PMC3420678 DOI: 10.1155/2011/134705] [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: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022] Open
Abstract
In this case, we describe an unusual presentation of a young woman with a rash typical of morphoea (confirmed on biopsy), who went on to develop myositis in an atypical distribution. Although the association of myositis with diffuse systemic sclerosis is well described, the link with localised scleroderma (morphoea) and myositis has not been described.
Collapse
|
34
|
Hansen CB, Callen JP. Connective tissue panniculitis: lupus panniculitis, dermatomyositis, morphea/scleroderma. Dermatol Ther 2010; 23:341-9. [DOI: 10.1111/j.1529-8019.2010.01334.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
35
|
Ramot Y, Sayama K, Sheffer R, Doviner V, Hiller N, Kaufmann-Yehezkely M, Zlotogorski A. Early-onset sensorineural hearing loss is a prominent feature of H syndrome. Int J Pediatr Otorhinolaryngol 2010; 74:825-7. [PMID: 20399510 DOI: 10.1016/j.ijporl.2010.03.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 03/22/2010] [Accepted: 03/23/2010] [Indexed: 11/30/2022]
Abstract
This case report describes two patients with H syndrome, a multisystemic autosomal recessive disorder, caused by mutations in the SLC29A3 gene. It is characterized by cutaneous hyperpigmentation, camptodactyly or flexion contractures and other features, among them hearing loss. The two patients had hearing loss as their presenting symptom, and had mutations in SLC29A3, one of them a novel mutation. The aim of this paper is to increase awareness to this recently described disorder, and to emphasize that H syndrome should be included in the differential diagnosis of congenital or acquired syndromic hearing loss in children.
Collapse
Affiliation(s)
- Yuval Ramot
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | | | | | | |
Collapse
|
36
|
Le EN, Freischlag JA, Christo PJ, Chhabra A, Wigley FM. Thoracic outlet syndrome secondary to localized scleroderma treated with botulinum toxin injection. Arthritis Care Res (Hoboken) 2010; 62:430-3. [PMID: 20391491 DOI: 10.1002/acr.20099] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elizabeth N Le
- Johns Hopkins School of Medicine, Baltimore, Maryland 21224, USA
| | | | | | | | | |
Collapse
|
37
|
Lu K, Chen J, Zhuo S, Zheng L, Jiang X, Zhu X, Zhao J. Multiphoton laser scanning microscopy of localized scleroderma. Skin Res Technol 2010; 15:489-95. [PMID: 19832963 DOI: 10.1111/j.1600-0846.2009.00395.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE A real-time, non-invasive method will confer a benefit for the diagnosis and treatment of localized scleroderma (LS) in the clinic. The aim of this work was to demonstrate the potential of multiphoton laser scanning microscopy (MPLSM) for diagnosing LS and monitoring the treatment response in vivo. METHODS Three sclerodermatous skin specimens and two normal skin specimens were investigated using MPLSM based on two-photon excitation fluorescence (TPEF) and second harmonic generation (SHG). MPLSM consists of a femtosecond Ti:sapphire laser and a scanning inverted microscope. Several parameters such as the epidermal thickness, the orientation ratio index of collagen bundles (ORICB), the spacing of collagen fibrin as well as the SHG to TPEF index of the dermis (STID) were developed to quantitatively discriminate the sclerodermatous skin from the normal skin. RESULTS The morphological differences were visualized obviously in the TPEF/SHG images of human skin (normal and sclerodermatous). The values of the developed parameters in normal skin were significantly different from that in sclerodermatous skin (P<0.05). CONCLUSION MPLSM could discriminate the sclerodermatous skin from the normal skin. With the advent of the clinical portability of typical MPLSM, this technique has great potential for application in the in vivo diagnosis of LS as well as for monitoring the treatment response.
Collapse
Affiliation(s)
- Kecheng Lu
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, China
| | | | | | | | | | | | | |
Collapse
|
38
|
Kroshinsky D, Kay J, Nazarian RM. Case records of the Massachusetts General Hospital. Case 37-2009. A 46-year-old woman with chronic renal failure, leg swelling, and skin changes. N Engl J Med 2009; 361:2166-76. [PMID: 19940302 DOI: 10.1056/nejmcpc0907802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
39
|
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.
Collapse
|
40
|
Neustadter JH, Samarin F, Carlson KR, Girardi M. Extracorporeal photochemotherapy for generalized deep morphea. ACTA ACUST UNITED AC 2009; 145:127-30. [PMID: 19221256 DOI: 10.1001/archdermatol.2008.547] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jason H Neustadter
- Department of Dermatology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520-8059, USA
| | | | | | | |
Collapse
|
41
|
Voermans NC, Pillen S, de Jong EM, Creemers MC, Lammens M, van Alfen N. Morphea profunda presenting as a neuromuscular mimic. J Clin Neuromuscul Dis 2008; 9:407-414. [PMID: 18525425 DOI: 10.1097/cnd.0b013e318175c495] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Localized scleroderma is characterized by idiopathic fibrosis of the skin and adjacent structures, and muscle involvement occurs predominantly in deep morphea. We report a patient with linear scleroderma who presented with slowly progressive atrophy, muscle weakness, and loss of function of her right arm, mimicking a neuromuscular disorder. Muscle biopsy eventually revealed zones of myositis, compatible with morphea profunda. Morphea profunda may thus present as a neuromuscular mimic, even in case of nonprogressive skin sclerosis. Myositis in morphea profunda is generally limited to one region, whereas inflammatory myopathies generally cause diffuse proximal muscle weakness and atrophy. Furthermore, skin changes in morphea profunda differ from those seen in dermatomyositis, and histological features of muscle biopsy can further distinguish between morphea profunda and inflammatory myopathies. Muscle biopsy in morphea profunda implies the risk of sampling error, whereas results of electromyography and muscle imaging might better represent the extent of muscle inflammation.
Collapse
Affiliation(s)
- N C Voermans
- Departments of Neurology, Neuromuscular Centre Nijmegen, Nijmegen Medical Centre, The Netherlands.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
Many conditions presenting with clinical hard skin and tissue fibrosis can be confused with systemic sclerosis (scleroderma). These disorders have very diverse etiologies and often an unclear pathogenetic mechanism. Distinct clinical characteristics, skin histology, and disease associations may allow one to distinguish these conditions from scleroderma and from each other. A prompt diagnosis is important to spare patients from ineffective treatments and inadequate management. This article highlights nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy), eosinophilic fasciitis (Shulman's syndrome), scleromyxedema, and scleredema. These often are detected in the primary care setting and referred to rheumatologists for further evaluation. Rheumatologists must be able to promptly recognize them to provide valuable prognostic information and appropriate treatment options for affected patients.
Collapse
Affiliation(s)
- Francesco Boin
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Suite 4100, Room 405, Baltimore, MD 21224, USA.
| | | |
Collapse
|