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Labonne C, Boutin D, Baali S, Roblot P, Frouin E, Renaud O, Hainaut E, Regnault MM. An uncommon case of epidermolysis bullosa acquisita associated with systemic sclerosis. Ann Dermatol Venereol 2023; 150:299-301. [PMID: 37596129 DOI: 10.1016/j.annder.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 08/20/2023]
Affiliation(s)
- C Labonne
- Department of Dermatology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France.
| | - D Boutin
- Department of Dermatology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - S Baali
- Department of Dermatology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - P Roblot
- LITEC, Université de Poitiers, 15 Rue de l'Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - E Frouin
- LITEC, Université de Poitiers, 15 Rue de l'Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; Department of Pathology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - O Renaud
- Department of Pathology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - E Hainaut
- Department of Dermatology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - M Masson Regnault
- Department of Dermatology, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France; LITEC, Université de Poitiers, 15 Rue de l'Hôtel-Dieu, TSA 71117, 86000 Poitiers, France
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2
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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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3
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Barrera-Ochoa CA, Eljure-Téllez J, Sáenz-Corral CI, De Anda-Juárez MC, Verdugo-Castro PN, Toussaint-Caire S, Vega-Memije ME. Two indurated bullous plaques on the upper back of an adult. Int J Dermatol 2020; 60:e130-e131. [PMID: 32860425 DOI: 10.1111/ijd.15162] [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: 07/22/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos A Barrera-Ochoa
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Juliana Eljure-Téllez
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Claudia I Sáenz-Corral
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Mariana C De Anda-Juárez
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Priscila N Verdugo-Castro
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Sonia Toussaint-Caire
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Maria E Vega-Memije
- Dermatology Department, Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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4
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George R, George A, Kumar TS. Update on Management of Morphea (Localized Scleroderma) in Children. Indian Dermatol Online J 2020; 11:135-145. [PMID: 32477969 PMCID: PMC7247622 DOI: 10.4103/idoj.idoj_284_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Juvenile localized scleroderma (morphea) is the predominant scleroderma in childhood which affects the skin and may extend to the underlying fascia, muscle, joints and bone. The assessment of activity and damage can be done with a validated instrument like LoSCAT. Disease classified as “low severity” which includes superficial plaque morphea can be treated with topical mid potent- potent steroids, tacrolimus, calcipotriol or imiquimod in combination with phototherapy. Methotrexate is recommended for linear, deep and generalized morphea. Steroids are effective in the early inflammatory stage and used in combination with methotrexate. Methotrexate is continued for at least 12 months after adequate response is achieved. Mycophenolate mofetil is given in cases where methotrexate is contraindicated or for those who do not respond to methotrexate. There are also reports of improvement of disease with ciclosporine and hydroxychloroquine. In severe cases, recalcitrant to standard therapy there may be a role for biologics, JAK inhibitors, and IVIG. Supportive measures like physiotherapy and psychiatric counseling are also important in the management of morphea. Orthopedic surgery and other measures like autologous fat transfer may be advocated once the disease is inactive.
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Affiliation(s)
- Renu George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anju George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - T Sathish Kumar
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India
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Leiferman KM, Peters MS. Eosinophil-Related Disease and the Skin. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1462-1482.e6. [DOI: 10.1016/j.jaip.2018.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023]
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6
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Wagner G, Meyer V, Sachse MM. [Generalized circumscribed scleroderma with blisters]. Hautarzt 2017; 68:566-570. [PMID: 28303284 DOI: 10.1007/s00105-017-3962-z] [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: 11/30/2022]
Abstract
The patient suffered from a 20-year course of generalized circumscribed scleroderma and presented with blisters in circumscribed areas of the affected skin. The development of subepidermal blisters has been described in all clinical forms of circumscribed scleroderma. Aetiology and pathogenesis of blister formation have not yet been clarified. An obstruction of the lymphatic vessels due to the present sclerosis is favoured. Treatment of bullous circumscribed scleroderma is considered to be difficult. Oral steroids, methotrexate, hydroxychloroquine and PUVA methods have been used with varying success.
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Affiliation(s)
- G Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
| | - V Meyer
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
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7
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Sánchez-Pérez S, Escandell-González I, Pinazo-Canales M, Jordá-Cuevas E. Bullous Morphea: Description of a New Case and Discussion of Etiologic and Pathogenic Factors in Bulla Formation. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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8
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Un nuevo caso de morfea ampollosa y discusión de los factores etiopatogénicos en la formación de las ampollas. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:75-76. [DOI: 10.1016/j.ad.2016.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/21/2022] Open
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Weichert GE, Bush KL, Crawford RI. Bullous Pilomatricoma: A Report of Clinical and Pathologic Findings and Review of Dermal Bullous Disorders. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Pilomatricoma is a common benign adnexal tumor differentiating toward elements of the hair matrix and shaft. It typically presents as a solitary, deep, dermal nodule. We describe a case of a pilomatricoma with the unusual feature of a thick-walled dermal bulla overlying the tumor. Objective: We describe a case of bullous pilomatricoma and discuss the potential etiology of the bullous feature of the lesion. Methods: This article includes a case report and a literature review. Conclusions: Bullous pilomatricoma has rarely been described. A common pathological feature in this type of pilomatricoma is the presence of dilated lymphatics. Bullous morphea associated with dermal lymphatic dilation has also been described. In both bullous pilomatricoma and morphea, it is possible that individual pathological features of the lesion lead to obstruction and congestion of the dermal lymphatics thereby inducing enough dilation and edema to form a dermal bulla. Antécédents: Le pilomatrixome (épithéliome calcifiant de Malherbe) est une tumeur annexielle bénigne qui ressemble aux éléments de la matrice et de la tige pilaires. Il se manifeste typiquement par un nodule sous-cutané solitaire. Nous rapportons un cas de pilomatrixome présentant la caractéristique inhabituelle d'une bulle dermique à paroi épaisse située au-dessus de la tumeur. Objectifs: Décrire un cas de pilomatrixome bulleux et présenter l'étiologie potentielle d'une telle manifestation. Méthodes: Cet article comporte une étude de cas ainsi qu'une revue de la littérature. Conclusion: Le pilomatrixome bulleux a rarement été décrit. La dilatation des vaisseaux lymphatiques constitue une manifestation pathologique fréquente de cette forme de pilomatrixome. La morphée bulleuse a également été associée à une dilatation de vaisseaux lymphatiques. Il est possible que les caractéristiques pathologiques individuelles des lésions du pilomatrixome bulleux et de la morphée entraînent une obstruction et une congestion des vaisseaux lymphatiques, provoquant ainsi une dilatation et un œdème suffisamment importants pour former une bulle.
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Affiliation(s)
- Gabriele E. Weichert
- Division of Dermatology, St. Paul's
Hospital and University of British Columbia, Vancouver, British Columbia,
Canada
| | - Kevin L. Bush
- Division of Plastic Surgery, St.
Paul's Hospital and University of British Columbia, Vancouver, British Columbia,
Canada
| | - Richard I. Crawford
- Division of Dermatology, St. Paul's
Hospital and University of British Columbia, Vancouver, British Columbia,
Canada
- Division of Anatomic Pathology, St.
Paul's Hospital and University of British Columbia, Vancouver, British Columbia,
Canada
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10
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Abstract
This review summarizes the literature on scleratrophic skin lesions as a manifestation of aBorreliainfection. An association of morphea with Lyme borreliosis was mainly reported from Middle-European Countries, Japan and South America.B. afzeliihas been identified predominantly from the chronic skin lesions of acrodermatitis chronica atrophicans (ACA) and has been cultivated from morphea lesions in isolated cases. Scleratrophic skin lesions like morphea, lichen sclerosus et atrophicus (LSA) and anetoderma have been observed in coexistence with ACA. Since all these diseases show clinical and histological similarities, they might have a common origin. The laboratory results that point to a borrelial origin of these diseases, however, are contradictory. Antibodies againstB. burgdorferiwere detected in up to 50% of patients.BorreliaDNA was shown in up to 33% of morphea and 50% of LSA patients.Borreliawere visualized on histological slides by polyclonal antibodies in up to 69% of morphea and 63% of LSA patients. In other reports no evidence ofBorrelia– associated morphea or LSA has been reported. For anetoderma, single case reports showed positiveBorreliaserology and/or PCR and a response to antibiotic treatment. The response of scleratrophic skin lesions to antibiotic treatment varies and can be seen in patients with or without a proven association to aBorreliainfection. This suggests that scleratrophic diseases might be of heterogeneous origin, but aBorreliainfection could be one cause of these dermatoses.
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11
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Yazdanpanah MJ, Sharifi N, Khooei A, Banihashemi M, Khaje-Daluee M, Shamsi A, Ghazvini K. Frequency of Borrelia in Morphea Lesion by Polymerase Chain Reaction in Northeast of Iran. Jundishapur J Microbiol 2015; 8:e19730. [PMID: 26468360 PMCID: PMC4601107 DOI: 10.5812/jjm.19730v2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 11/27/2022] Open
Abstract
Background: The etiology of morphea is still unknown. Borrelia spp. as a causative agent of morphea has been discussed since 1985, but the relationship remains uncertain. Objectives: We aimed to find the frequency of Borrelia in morphea lesions by polymerase chain reaction (PCR) in northeast of Iran. Patients and Methods: Sixty six patients with morphea were prospectively included in the present study. For each patient, formalin-fixed, paraffin-embedded tissue blocks of skin lesion biopsies were examined for Borrelia spp. DNA using PCR. Results: No Borrelia DNA was detected by PCR in skin lesions of patients with morphea. Conclusions: The result of this study showed no relationship between Borrelia infection and morphea lesions and in other word indicated that morphea, at least in Iran, is not caused by Borrelia spp.
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Affiliation(s)
- Mohhamad Javad Yazdanpanah
- Department of Dermatology, Research Center for Skin Diseases and Cutaneous Leishmaniasis, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Norieh Sharifi
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Alireza Khooei
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahnaz Banihashemi
- Department of Dermatology, Research Center for Skin Diseases and Cutaneous Leishmaniasis, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Khaje-Daluee
- Department of Social Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Azadeh Shamsi
- Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Kiarash Ghazvini
- Antimicrobial Resistance Research Center, Department of Microbiology and Virology, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Kiarash Ghazvini, Antimicrobial Resistance Research Center, Department of Microbiology and Virology, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118012589; +98-9151248938, Fax: +98-5118409612, E-mail:
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12
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Careta MF, Romiti R. Localized scleroderma: clinical spectrum and therapeutic update. An Bras Dermatol 2015; 90:62-73. [PMID: 25672301 PMCID: PMC4323700 DOI: 10.1590/abd1806-4841.20152890] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/11/2013] [Indexed: 12/31/2022] Open
Abstract
Scleroderma is a rare connective tissue disease that is manifested by cutaneous
sclerosis and variable systemic involvement. Two categories of scleroderma are known:
systemic sclerosis, characterized by cutaneous sclerosis and visceral involvement,
and localized scleroderma or morphea which classically presents benign and
self-limited evolution and is confined to the skin and/or underlying tissues.
Localized scleroderma is a rare disease of unknown etiology. Recent studies show that
the localized form may affect internal organs and have variable morbidity. Treatment
should be started very early, before complications occur due to the high morbidity of
localized scleroderma. In this review, we report the most important aspects and
particularities in the treatment of patients diagnosed with localized
scleroderma.
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13
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Tolkachjov SN, Patel NG, Tollefson MM. Progressive hemifacial atrophy: a review. Orphanet J Rare Dis 2015; 10:39. [PMID: 25881068 PMCID: PMC4391548 DOI: 10.1186/s13023-015-0250-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background Progressive Hemifacial Atrophy (PHA) is an acquired, typically unilateral, facial distortion with unknown etiology. The true incidence of this disorder has not been reported, but it is often regarded as a subtype of localized scleroderma. Historically, a debate existed whether PHA is a form of linear scleroderma, called morphea en coup de sabre (ECDS), or whether these conditions are inherently different processes or appear on a spectrum (; Adv Exp Med Biol 455:101–4, 1999; J Eur Acad Dermatol Venereol 19:403–4, 2005). Currently, it is generally accepted that both diseases exist on a spectrum of localized scleroderma and often coexist. The pathogenesis of PHA has not been delineated, but trauma, autoimmunity, infection, and autonomic dysregulation have all been suggested. The majority of patients have initial manifestations in the first two decades of life; however, late presentations in 6th and 7th decades are also described [J Am Acad Dermatol 56:257–63, 2007; J Postgrad Med 51:135–6, 2005; Neurology 61:674–6, 2003]. The typical course of PHA is slow progression over 2-20 years and eventually reaching quiescence. Systemic associations of PHA are protean, but neurological manifestations of seizures and headaches are common [J Am Acad Dermatol 56:257–63, 2007; Neurology 48:1013–8, 1997; Semin Arthritis Rheum 43:335–47, 2013]. As in many rare diseases, standard guidelines for imaging, treatment, and follow-up are not defined. Methods This review is based on a literature search using PubMed including original articles, reviews, cases and clinical guidelines. The search terms were “idiopathic hemifacial atrophy”, “Parry-Romberg syndrome”, “Romberg’s syndrome”, “progressive hemifacial atrophy”, “progressive facial hemiatrophy”, “juvenile localized scleroderma”, “linear scleroderma”, and “morphea en coup de sabre”. The goal of this review is to summarize clinical findings, theories of pathogenesis, diagnosis, clinical course, and proposed treatments of progressive hemifacial atrophy using a detailed review of literature. Inclusion- and exclusion criteria Review articles were used to identify primary papers of interest while retrospective cohort studies, case series, case reports, and treatment analyses in the English language literature or available translations of international literature were included.
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Affiliation(s)
| | - Nirav G Patel
- Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Megha M Tollefson
- Mayo Clinic, Department of Dermatology, 200 First Street SW, Rochester, MN, 55905, USA.
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Fernandez-Flores A, Gatica-Torres M, Tinoco-Fragoso F, García-Hidalgo L, Monroy E, Saeb-Lima M. Three cases of bullous morphea: histopathologic findings with implications regarding pathogenesis. J Cutan Pathol 2014; 42:144-9. [DOI: 10.1111/cup.12418] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michelle Gatica-Torres
- Department of Dermatology; Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”; Mexico City Mexico
| | - Fátima Tinoco-Fragoso
- Department of Dermatology; Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”; Mexico City Mexico
| | - Linda García-Hidalgo
- Department of Dermatology; Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”; Mexico City Mexico
| | - Elena Monroy
- Dermatology and Mycology; San Cristobal de las Casas Private Practice; Chiapas Mexico
| | - Marcela Saeb-Lima
- Department of Pathology; Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”; Mexico City Mexico
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Jachiet M, de Masson A, Peffault de Latour R, Rybojad M, Robin M, Bourhis JH, Xhaard A, Dhedin N, Sicre de Fontbrune F, Suarez F, Barete S, Parquet N, Nguyen S, Ades L, Rubio MT, Wittnebel S, Bagot M, Socié G, Bouaziz JD. Skin ulcers related to chronic graft-versus-host disease: clinical findings and associated morbidity. Br J Dermatol 2014; 171:63-8. [DOI: 10.1111/bjd.12828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Jachiet
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - A. de Masson
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - R. Peffault de Latour
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - M. Rybojad
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - M. Robin
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - J.-H. Bourhis
- Department of Haematology; AP-HP; Institut Gustave Roussy; Villejuif France
| | - A. Xhaard
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - N. Dhedin
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - F. Sicre de Fontbrune
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - F. Suarez
- Department of Haematology; AP-HP; Hôpital Necker; Paris France
| | - S. Barete
- Department of Dermatology; AP-HP; Hôpital Pitié Salpêtrière; Paris France
| | - N. Parquet
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - S. Nguyen
- Department of Haematology; AP-HP; Hôpital Pitié Salpêtrière; Paris France
| | - L. Ades
- Departments of Haematology; AP-HP; Hôpital Avicenne; Bobigny France
| | - M.-T. Rubio
- Department of Haematology; AP-HP; Hôpital Saint Antoine; Paris France
| | - S. Wittnebel
- Department of Haematology; AP-HP; Institut Gustave Roussy; Villejuif France
| | - M. Bagot
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - G. Socié
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - J.-D. Bouaziz
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
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17
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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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Rosato E, Veneziano ML, Di Mario A, Molinaro I, Pisarri S, Salsano F. Ulcers caused by bullous morphea: successful therapy with N-acetylcysteine and topical wound care. Int J Immunopathol Pharmacol 2013; 26:259-62. [PMID: 23527731 DOI: 10.1177/039463201302600128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bullous morphea is an uncommon form of localized scleroderma. The pathogenesis is unknown and treatment of coexistent ulcers is difficult. The pathogenesis of bullae formation in morphea is multifactorial, but reactive oxygen species production appears to play a key role. We report a patient with bullous morphea with long-standing ulcers whom we successfully treated with N-acetylcysteine and topical wound care. N-acetylcysteine, an antioxidant sulfhydryl substance, promotes the healing of ulcers in patients with bullous morphea.
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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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Yasar S, Mumcuoglu CT, Serdar ZA, Gunes P. A case of lichen sclerosus et atrophicus accompanying bullous morphea. Ann Dermatol 2011; 23:S354-9. [PMID: 22346277 PMCID: PMC3276796 DOI: 10.5021/ad.2011.23.s3.s354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/08/2022] Open
Abstract
Bullous morphea is a rare form of morphea characterized with bullae on or around atrophic morphea plaques. Whereas lichen sclerosus et atrophicus (LSA) is a disease the etiology of which is not fully known, and which is characterized with sclerosis. Coexistence of morphea and LSA has been identified in some cases. Some authors believe that these two diseases are different manifestations which are on the same spectrum. The 70-year-old patient stated herein, presented to us for 6 months with annular, atrophic plaques, ivory color in the middle, surrounded by living erythema, on the front and back of the trunk. Occasionally bulla formation on the plaques on the trunk lateral was identified. Fibrotic and atrophic plaques of ligneous hardness were present on the front side of tibia of both legs. In the histopathologic examination, the lesions were found concordant with bullous morphea and LSA. With colchicine 1.5 mg/day, pentoxifylline 1,200 mg/day, topical calcipotriol ointment and clobetasol propionate cream, the erythema in the patient's lesions faded and softening in the fibrotic plaques was observed. Concomitance of bullous morphea and LSA is a rarely seen, interesting coexistence which suggests a common, as yet unknown, underlying pathogenesis.
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Affiliation(s)
- Sirin Yasar
- Department of Dermatology, Haydarpaş Numune Training and Research Hospital, Istansbul, Turkey
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Samimi M, Maruani A, Machet MC, Baulieu F, Machet L, Lorette G. Lymphatic compression by sclerotic patches of morphea: an original mechanism of lymphedema in a child. Pediatr Dermatol 2010; 27:58-61. [PMID: 20199412 DOI: 10.1111/j.1525-1470.2009.01049.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lymphedema in children is mostly primary, due to lymphatic hypoplasia. Secondary lymphedema is caused by lymphatic injury or obstruction. We report the case of a child that developed a lymphedema of the left upper and lower extremities, with a simultaneous onset of ipsilateral hemicorporal morphea. We concluded that lymphatic obstruction was due to sclerosis from morphea. This is a unique, rarely reported mechanism of lymphedema. Lymphoscintigraphy revealed attenuated lymphatic flow in the left upper and lower limbs. Systemic corticosteroids were associated with slow improvement in the sclerotic patches. We simultaneously noticed an improvement in the lymphedema of limbs. Repeat lymphoscintigraphy revealed dramatically improved lymphatic function. This case suggests that at least in some cases lymphedema may be caused by morphea.
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Schlaak M, Friedlein H, Kauer F, Renner R, Rogalski C, Simon JC. Successful therapy of a patient with therapy recalcitrant generalized bullous scleroderma by extracorporeal photopheresis and mycophenolate mofetil. J Eur Acad Dermatol Venereol 2008; 22:631-3. [PMID: 18410628 DOI: 10.1111/j.1468-3083.2007.02403.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leiferman KM, Gleich GJ, Peters MS. Dermatologic Manifestations of the Hypereosinophilic Syndromes. Immunol Allergy Clin North Am 2007; 27:415-41. [PMID: 17868857 DOI: 10.1016/j.iac.2007.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Skin is a commonly affected organ in hypereosinophilic syndromes (HES). Cutaneous lesions may be an important presenting sign, may be extremely debilitating, and often reflect disease activity in HES. Recognition of dermatologic manifestations is important in approaching diagnosis and treatment of HES. This article reviews cutaneous involvement in HES and other eosinophil-associated skin diseases.
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Affiliation(s)
- Kristin M Leiferman
- Department of Dermatology, 4B454 School of Medicine, University of Utah Health Sciences Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132-2409, USA.
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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
We describe a 2-year-old African-American boy with a 4-month history of gradually worsening unilateral edema that was initially noted on his left hand and then approximately 2 weeks later on his left lower extremity. In addition, linear hypopigmented patches were noted along the left forearm and leg, with no appreciable scarring or induration. The edema on the left-hand side of his body progressed so that he developed tense bullae on his left hand. Two months later, the hypopigmented patches were indurated and bound-down, especially over the left groin and thigh. A biopsy specimen from this area showed features characteristic of morphea. In this patient, dilated lymphatic channels secondary to the sclerosis of the morphea caused the bullae. Bullous morphea is a rare condition. We were unable to find any reports its occurrence in children under 18 with associated lymphedema. This entity should be included in the differential for acquired unilateral edema in children.
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Affiliation(s)
- Katherine H Fiala
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Pérez-Gala S, Delgado-Jiménez Y, Aragüés M, Fraga J, García-Díez A. [Single blister in pretibial region]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:354-6. [PMID: 16956573 DOI: 10.1016/s0001-7310(06)73419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Silvia Pérez-Gala
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
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Lai Cheong JE, Chaudhry SI, Black MM. Blistering plaques. Clin Exp Dermatol 2005; 31:163-4. [PMID: 16309532 DOI: 10.1111/j.1365-2230.2005.01957.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J E Lai Cheong
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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Kim SK, Kim YC, Lee BJ, Kang HY. Scleroderma-like changes in cutaneous eruption of rhabdomyolysis. J Am Acad Dermatol 2005; 53:177-8. [PMID: 15965450 DOI: 10.1016/j.jaad.2005.01.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
This article discusses the various clinical, laboratory, and therapeutic aspects of systemic sclerosis and localized scleroderma in children. The close collaboration among pediatricians, rheumatologists, and dermatologists represents an important advance in the management of these disabling conditions.
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Affiliation(s)
- Francesco Zulian
- Pediatric Rheumatology Unit, Department of Pediatrics, University of Padova, Via Giustiniani 3 35128, Padua, Italy.
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30
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Tsunemi Y, Ihn H, Saeki H, Tamaki K. A case of lichen sclerosus et atrophicus with marked fibrosis in the dermis: analysis of fibrogenetic cytokines by reverse transcriptase-polymerase chain reaction. J Dermatol 2004; 31:142-5. [PMID: 15160873 DOI: 10.1111/j.1346-8138.2004.tb00526.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Kowalewski C, Kozlowska A, Zawadzka M, Woźniak K, Blaszczyk M, Jablońska S. Alterations of Basement Membrane Zone in Bullous and Non-Bullous Variants of Extragenital Lichen Sclerosus. Am J Dermatopathol 2004; 26:96-101. [PMID: 15024189 DOI: 10.1097/00000372-200404000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the study was to compare alterations of various regions of the basement membrane zone (BMZ) in lichen sclerosus (LS) using laser scanning confocal microscopy. The study included three cases of bullous LS, one case of bullous LS that developed in the course of graft-versus-host disease (GVHD), and six cases of non-bullous LS. Three cases of morphea served as a control. Biopsies from patients' skin and control biopsies from normal human skin were cut into 30-microm thick slides and labeled with antibodies against beta4-intergin (lamina lucida marker), collagen IV, and the N-terminal end of collagen VII (lamina densa markers) and the C-terminal end of collagen VII (sublamina densa marker) using routine immunofluorescence (IF). Three-dimensional (3D) reconstruction of various regions of the BMZ showed a decrease in the number and size of the dermal papillae in LS and morphea as compared with normal skin. In LS numerous invaginations and holes were present in the BMZ at the level of the lamina lucida and lamina densa. Computer animation of 3D projections revealed that the thickness of the lamina densa observed under the light microscopy is an optical artifact dependent on periodical tortion of the lamina densa along its axis. Torsions and invaginations of the BMZ are equally responsible for the phenomenon of artificial reduplication of the lamina densa observed at the ultrastructural level. IF labeling with antibody against the N-terminal end of collagen VII disclosed the presence of a large hole (up to 25 microm) in the lamina densa and the presence of granular material in deep dermis suggestive of partial degradation of lamina densa at the level of anchoring fibers. An IF mapping study showed blister formation below the lamina densa in three patients with bullous LS, whereas in a case of LS associated with GVHD, a blister formed through the basal layer of the epidermis. In morphea, there was flattening of BMZ at the level of lamina lucida, lamina densa, and sublamina densa but the continuity of BMZ was preserved. Three-dimensional reconstruction of dermal-epidermal junction in LS revealed alterations of the BMZ, most pronounced at the level of the lamina densa and sublamina densa.
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Abstract
Bullous morphea is an uncommon form of localized scleroderma. The exact pathogenesis is unknown and treatment of the accompanying ulcers is problematic. We report a patient with bullous morphea with long-standing ulcers whom we successfully treated with the tissue-engineered skin Apligraf (Organogenesis Inc., Canton, MA). The patient experienced rapid improvement in granulation tissue and the ulcers healed 4 months after a single application. The rationale for the use of Apligraf is based on experience with patients with venous ulcers who have surrounding peri-ulcer fibrosis. This condition, termed lipodermatosclerosis, has been reported as a poor prognostic factor for healing, yet many ulcers associated with lipodermatosclerosis may respond to treatment with tissue-engineered skin. Taken in concert, these results suggest a role for tissue- engineered skin in the treatment of chronic wounds with surrounding fibrosis.
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Affiliation(s)
- Lucy K Martin
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, and Veterans Administration Medical Center, Miami, FL 33125, USA
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Moreno JC, Valverde F, Martinez F, Vélez A, Torres A, Fanego J, Ocaña MS. Bullous scleroderma-like changes in chronic graft-versus-host disease. J Eur Acad Dermatol Venereol 2003; 17:200-3. [PMID: 12705752 DOI: 10.1046/j.1468-3083.2003.00606.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cutaneous graft-versus-host disease (GVHD) is the most common clinical setting for GVHD after bone marrow transplantation. Chronic cutaneous GVHD is categorized according to the type of skin lesions into lichenoid and sclerodermoid variants, but bullous scleroderma-like changes are exceptional. Recently, we studied a patient with these alterations. This is the second case described in the literature.
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Affiliation(s)
- J C Moreno
- Department of Dermatology, Hospital Universitario Reina Sofia, C/Av. Menendez Pidal s/n, 14007 Córdoba, Spain.
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Goodlad JR, Davidson MM, Gordon P, Billington R, Ho-Yen DO. Morphoea and Borrelia burgdorferi: results from the Scottish Highlands in the context of the world literature. Mol Pathol 2002; 55:374-8. [PMID: 12456775 PMCID: PMC1187274 DOI: 10.1136/mp.55.6.374] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Previous studies investigating the link between infection with Borrelia burgdorferi and morphoea have produced conflicting results. Often, these studies have been undertaken in patients from different regions or countries, and using methods of varying sensitivity for detecting Borrelia burgdorferi infection. This study aimed to establish whether a relation could be demonstrated in the Highlands of Scotland, an area with endemic Lyme disease, with the use of a sensitive method for detecting the organism. METHODS The study was performed on biopsies of lesional skin taken from 16 patients from the Highlands of Scotland with typical clinical features of morphoea. After histological confirmation of the diagnosis, a nested polymerase chain reaction (PCR) using primers to a unique conserved region of the Borrelia burgdorferi flagellin gene was performed on DNA extracts from each biopsy. A literature search was also performed for comparable studies. RESULTS None of the 16 patients had documented clinical evidence of previous infection with B burgdorferi. DNA was successfully extracted from 14 of the 16 cases but all of these were negative using PCR for B burgdorferi specific DNA, despite successful amplification of appropriate positive controls in every test. The results were compared with those of other documented studies. CONCLUSIONS Examination of the literature suggests that there is a strong geographical relation between B burgdorferi and morphoea. These results, in which no such association was found, indicate that morphoea may not be associated with the subspecies of B burgdorferi found in the Highlands of Scotland.
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Affiliation(s)
- J R Goodlad
- Department of Pathology, Highland Acute Hospitals NHS Trust, Raigmore Hospital, Inverness IV2 3UJ, UK.
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Drage LA, Davis MDP, De Castro F, Van Keulen V, Weiss EA, Gleich GJ, Leiferman KM. Evidence for pathogenic involvementof eosinophils and neutrophilsin Churg-Strauss syndrome. J Am Acad Dermatol 2002; 47:209-16. [PMID: 12140466 DOI: 10.1067/mjd.2002.124600] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Churg-Strauss syndrome (CSS) is a multi-organ disease with tissue and blood eosinophilia. OBJECTIVE Our aim was to study eosinophil and neutrophil involvement in CSS. METHODS Eight lesional skin biopsy specimens from 6 patients with CSS and serum and blister fluid from one patient were tested for eosinophil and neutrophil activity. Indirect immunofluorescence on skin specimens used antibodies to eosinophil granule major basic protein (MBP), eosinophil-derived neurotoxin (EDN), and neutrophil elastase (NE). Serum and blister fluid specimens were analyzed for granule protein levels and for eosinophil-activating cytokines. RESULTS Indirect immunofluorescence showed prominent cellular and extracellular staining for EDN in skin biopsy specimens; MBP staining was less extensive. Five biopsy specimens showed marked cellular NE staining; 4 showed prominent extracellular NE. Serum and blister fluid specimens contained elevated MBP, EDN, and interleukin 5 levels and enhanced eosinophil survival in culture. Granulocyte-macrophage colony-stimulating factor and interleukin 5 were detected in blister fluid. Blister fluid contained more NE than normal serum. CONCLUSIONS Both eosinophils and neutrophils likely participate in skin lesion development in CSS.
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Affiliation(s)
- Lisa A Drage
- Department of Dermatology, Mayo Clinic/Mayo Foundation, Rochester, USA
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Abstract
BACKGROUND The occurrence of bullous lesions in localized or systemic scleroderma is rare. Three histologic patterns have been reported: lichen sclerosus et atrophicus-like, lymphangiectatic blisters and autoimmune blistering diseases. OBJECTIVE To investigate the frequency, clinical, and immunopathologic features of patients with scleroderma and bullous eruptions and to review the literature regarding this rare condition. METHODS A retrospective study of 53 cases of scleroderma (localized, generalized, and systemic) in the dermatology and rheumatology clinics at one institution over an 8-year span. Clinical, serologic, and immunopathologic findings were analyzed in four cases. RESULTS Four of 53 patients exhibited bullous lesions in association with scleroderma. The first case illustrates lymphangioma-like clinical and pathologic presentation. The second case demonstrates bullous lichen sclerosus et atrophicus-like pattern. The other two cases exemplify a superimposed autoimmune skin disease, epidermolysis bullosa acquisita and penicillamine induced pemphigus foliaceus after treatment for systemic scleroderma. CONCLUSIONS Of the 53 original patients, we have described four cases of bullous scleroderma (7.5%) Illustrating several pathogenetic mechanisms of bulla formation. inflammatory (lichen sclerosus et atrophicus), fibrotic/obstructive (lymphangiomatous), autoimmune (epidermolysis bullosa acquisita), and pemphigus foliaceus. The final case illustrates bullae as a complication of therapy for the underlying scleroderma.
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Affiliation(s)
- Adrienne Rencic
- Department of Dermatology, of Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Abstract
The aetiology of morphoea and lichen sclerosus et atrophicus is still unknown. Since the detection of Borrelia burgdorferi (B. burgdorferi) as the causative agent of Lyme disease, there has been debate about a possible association between B. burgdorferi and morphoea. Initial serological and cultural studies showed controversial results. The introduction of polymerase chain reaction (PCR) initially suggested an association between B. burgdorferi and morphoea. We reviewed the literature on B. burgdorferi (specific serology, immunohistology, culture, lymphocyte stimulation and DNA detection by PCR) since 1983, using Medline and Current Contents. Histological and immunohistological detection of B. burgdorferi was reported in 0-40% (20 of 82) of the cases with morphoea and in 46-50% (17 of 36) of the cases with lichen sclerosus et atrophicus. Cultivation of spirochetes from lesional skin succeeded in five patients (five of 68) with morphoea, but failed in patients with lichen sclerosus et atrophicus. In Europe and Asia, serological detection of antibodies against B. burgdorferi was described in 0-60% (138 of 609) of patients with morphoea and in 19% (six of 32) in the U.S.A. For lichen sclerosus et atrophicus 0-25% of the published cases (three of 23) in Europe and Asia were seropositive. DNA from B. burgdorferi was detected by PCR in 0-100% (17 of 82) of the tissues of patients with morphoea in Europe and Asia, but not a single case among 98 patients was reported to be positive from the U. S.A. In Europe and Asia, borrelial DNA was detected in 0-100% (nine of 28) of the cases with lichen sclerosus et atrophicus, whereas in the U.S.A. none of 48 patients was positive. There are two possible explanations for these contradictory findings: the most likely is that B. burgdorferi is not a causative agent for morphoea. Another possible explanation could be that a subset of morphoea is caused by a special subspecies of B. burgdorferi that is present in Europe and Asia but does not occur in the U.S.A.
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Affiliation(s)
- B Weide
- Department of Dermatology, Eberhard-Karls-University of Tuebingen, Liebermeisterstrasse 25, D-72076 Tuebingen, Germany
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Vierra E, Cunningham BB. Morphea and localized scleroderma in children. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1999; 18:210-25. [PMID: 10468041 DOI: 10.1016/s1085-5629(99)80019-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Localized scleroderma refers to a diverse spectrum of disorders that involve fibrosis of the skin. Children are more likely than adults to develop localized forms of scleroderma. This condition may have devastating effects on growth and development such as limb asymmetry, flexion contractures, and psychological disability. The pathogenesis of localized scleroderma is unknown but its possible relation to Borrelial infection is discussed. This article reviews associated laboratory and radiologic abnormalities, and discusses implications for monitoring disease activity. There is no universally effective therapy for this idiopathic condition and therapy is limited. A rationale for treatment based on disease subtype and severity is provided.
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Affiliation(s)
- E Vierra
- Department of Medicine (Dermatology), University of California at San Diego, Children's Hospital and Health Center, USA
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40
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Davis MD, Perniciaro C, Dahl PR, Randle HW, McEvoy MT, Leiferman KM. Exaggerated arthropod-bite lesions in patients with chronic lymphocytic leukemia: a clinical, histopathologic, and immunopathologic study of eight patients. J Am Acad Dermatol 1998; 39:27-35. [PMID: 9674394 DOI: 10.1016/s0190-9622(98)70398-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Unusual papulovesicular lesions resembling arthropod bites have been described in patients with chronic lymphocytic leukemia (CLL). OBJECTIVE Our purpose was to describe and characterize further the clinical, histopathologic, and immunopathologic features of these lesions. METHODS Eight patients were identified retrospectively who had CLL and characteristic skin lesions. Clinical and histologic features were recorded. Skin biopsy specimens were analyzed immunohistochemically for eosinophil granule major basic protein, eosinophil-derived neurotoxin, neutrophil elastase, and mast cell tryptase. RESULTS The clinical features, including the lesional distribution, suggested arthropod bites, although most patients could not recall having been bitten. Mixed T- and B-cell lymphoid cell infiltrates were present within lesions, along with prominent eosinophil infiltration and eosinophil granule protein deposition. CONCLUSION Exuberant papulovesicular lesions develop in patients with CLL apparently as an exaggerated response to arthropod bites. Prominent eosinophil infiltration and degranulation within these lesions likely contribute to the severity of symptoms.
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Affiliation(s)
- M D Davis
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
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Nelson AM. Localized scleroderma including morphea, linear scleroderma, and eosinophilic fasciitis. CURRENT PROBLEMS IN PEDIATRICS 1996; 26:318-24. [PMID: 8922521 DOI: 10.1016/s0045-9380(96)80011-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A M Nelson
- Mayo Medical School, Rochester, Minnesota, USA
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Affiliation(s)
- B T Williams
- Department of Dermatology, University of California, Irvine, USA
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44
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Abstract
OBJECTIVE To classify and describe morphea (localized scleroderma). DESIGN A review of morphea and its subtypes is presented. RESULTS The current classification of morphea is incomplete and confusing. As knowledge of the spectrum of disease continues to evolve, the controversy and confusing nature of its multiple subtypes present a challenge for the physician who encounters a patient with this condition. Thus, we propose that morphea be classified into the following five groups: plaque, generalized, bullous, linear, and deep. This classification, based on clinical morphologic findings, will simplify the diagnostic and therapeutic approach. CONCLUSION Morphea represents a wide variety of clinical entities that seen to be on the opposite end of the scleroderma spectrum from systemic sclerosis. The cutaneous lesions eventually evolve from a sclerotic stage to a nonindurated stage, and residual hypopigmentation or hyperpigmentation follows. The histologic pattern in patients with morphea is similar to that in patients with progressive systemic sclerosis. Although treatment is nonstandardized, hydroxychloroquine sulfate may be beneficial.
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Affiliation(s)
- L S Peterson
- Division of Rheumatology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA
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