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Albagieh H, Alshagroud RS, Aladnan AM, Aldosari B, Alburaykan YB, Almashham LY, Alqasem AA, Alyahya AA, Aboheimed NI. Morphea Involving the Lips and Gingiva: A Rare Case Report. Cureus 2023; 15:e51202. [PMID: 38155978 PMCID: PMC10754225 DOI: 10.7759/cureus.51202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 12/30/2023] Open
Abstract
Morphea is a subtype of scleroderma that does not involve Raynaud's phenomenon or internal organ involvement. It is a connective tissue disease that features the excessive deposition of collagen in the dermis and subcutaneous tissue, leading to a thickening of the dermis and subcutaneous tissue, eventually forming a scar-like lesion. We represent a 19-year-old male Saudi patient displaying a white patch on the marginal gingiva of tooth #21 and multiple yellowish papules on the outer surface of the lip. Both teeth #21 and #22 have experienced recession and bone loss. The patient's clinical history and histopathology revealed characteristic features of localized scleroderma. A treatment was proposed involving immunosuppressants, methotrexate, and pimecrolimus cream along with topical corticosteroids and excimer laser therapy (308 nm). The patient followed the treatment plan for a full month and the white patch quickly improved for the patient. Afterward, the patient has been taking only methotrexate with a significant but gradual improvement. In this paper, we discuss the differential diagnosis to be considered and present an unusual occurrence of localized scleroderma in the oral cavity.
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Affiliation(s)
- Hamad Albagieh
- Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, SAU
| | - Rana S Alshagroud
- Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, SAU
| | | | - Bader Aldosari
- Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, SAU
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Wróblewska A, Polańska A, Mojs E, Żaba R, Adamski Z, Dańczak-Pazdrowska A. Disturbances of the stomatognathic system and possibilities of its correction in patients with craniofacial morphea. Postepy Dermatol Alergol 2023; 40:592-598. [PMID: 38028421 PMCID: PMC10646717 DOI: 10.5114/ada.2023.131865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
Morphea en coup de sabre and progressive hemifacial atrophy are extremely rare connective tissue disorders causing facial deformity. In extreme cases, morphological disorders are accompanied by symptoms of a clear impairment of the stomatognathic system. The aetiology of the above-mentioned diseases is still unknown. Properly planned therapy in the field of maxillofacial orthopaedics makes it possible to correct the asymmetric pattern of hard tissue growth and thus enable rehabilitation. The task of augmentation techniques is the volumetric supplementation of tissue defects resulting from atrophic processes. The degree of destruction and the extent of changes determine the method of correction. Mild and moderate defects are treated mainly with biomaterials and autologous adipose tissue. The severe course of hemifacial atrophy and morphea en coup de sabre and the associated significant tissue atrophy necessitate the search for more complex methods of treatment. In this paper, we summarize the disturbances of the stomatognathic system in patients with craniofacial morphea, together with an analysis of current treatment options.
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Affiliation(s)
- Agnieszka Wróblewska
- Student of Postgraduate Studies Facial Aesthetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Fan W, Obiakor B, Jacobson R, Haemel A, Gandelman J. Clinical and therapeutic course in head variants of linear morphea in adults: a retrospective review. Arch Dermatol Res 2022; 315:1161-1170. [DOI: 10.1007/s00403-022-02478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
AbstractParry Romberg Syndrome (PRS) and en coup de sabre (ECDS) are head variants of linear morphea with functional and structural implications. This study describes the clinical course, autoimmune co-morbidities, complications, and treatment of adults with PRS/ECDS at a tertiary referral center. We retrospectively reviewed the records of all 34 adult patients with PRS/ECDS identified through billing code search and seen by dermatologists at our institution between 2015 and 2021. Eight patients (23.5%) had ECDS, 8 (23.5%) had PRS, and 18 (52.9%) had overlap. Twenty-six patients (76.5%) reported ocular, oral, and/or neurologic symptoms, and 8 (23.5%) had concomitant autoimmune/inflammatory conditions. Sixteen patients (47.1%) had a skin biopsy, and 25 (73.5%) had imaging. Forty-six MRIs were obtained, of which 6 (13.0%) reported intracranial findings and 25 (54.3%) reported disease-related connective tissue damage. Twenty-four patients (70.6%) underwent systemic treatment during their disease course per available clinical records. Seventeen patients (70.8%) had improved or stable disease upon treatment completion, with an average duration of 22.2 months. Ten patients (41.7%) reported recurrence of disease following the treatment course. To address changes to facial contour, 6 patients (17.6%) opted for procedural treatments. One patient (16.7%) experienced morphea reactivation following a filler injection performed off-immunosuppression. Compared to findings in children, our study suggests adults with PRS/ECDS are more likely to have oral and ocular complications but experience less severe neurologic symptoms. While systemic treatments appear beneficial in most adult patients with PRS/ECDS, disease may recur following discontinuation.
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Mainassara Chékaraou S, El Gaouzi R, Taleb B. Oral manifestations of morphea en plaque: Case report. Ann Med Surg (Lond) 2021; 71:102891. [PMID: 34691443 PMCID: PMC8515241 DOI: 10.1016/j.amsu.2021.102891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Morphea, or localized scleroderma, is an inflammatory disease that leads to sclerosis of the skin and underlying tissues due to excessive collagen deposition. Its etiology remains elusive. Morphea also affects oral and perioral tissues, the most common clinical manifestations being facial skin and tongue rigidity. Below, we present a case of morphea with oral manifestations. Case presentation A 17-year-old patient was referred to our department of oral surgery by her dermatologist for possible oral morphea involvement. She presented pigmented skin lesions involving the right labial-chin region. On palpation, the skin of her perioral was sclerotic. the panoramic radiograph showed a shortening of the roots of the 46/47 with a developmental delay of the 48 compared to the 38. A bone biopsy was performed between 46/47 and distal to 48. histological examination showed bone tissue with fibrous and collagenous reorganization in favor of scleroderma. Conclusion The management of plaque morphea is multidisciplinary. The role of the dentist is very important to avoid any oral complications. “Morphea en plaque”is a rare condition involving in oro-facial area. Its etiology remains elusiveand its diagnosis requires a careful clinical, radiographic and histological examination. Themanagement of plaque morphea is multidisciplinary. The role of the dentist is very important to avoid any oral complications.
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Affiliation(s)
| | - Rajae El Gaouzi
- Oral Surgery Resident, Faculty of Dental Medicine-Rabat, Mohammed V University of Rabat, Morocco
| | - Bouchra Taleb
- Oral Surgery, Faculty of Dental Medicine-Rabat, Mohammed V University of Rabat, Morocco
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Therapeutic and Reconstructive Management Options in Scleroderma (Morphea) en Coup de Sabre in Children and Adults. A Systematic Literature Review. J Clin Med 2021; 10:jcm10194517. [PMID: 34640533 PMCID: PMC8509267 DOI: 10.3390/jcm10194517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 01/15/2023] Open
Abstract
Scleroderma (morphea) en coup de sabre is a localized subtype restricted to the frontoparietal region of the head. Current treatment paradigms rely on low levels of evidence, primarily case reports and case series-supported by expert opinions. The aim of this article was to systematically analyze current data related to the treatment of localized scleroderma en coup de sabre. The databases Scopus, PubMed, and EBSCO were searched for all reports discussing the treatment of localized scleroderma en coup de sabre. The keywords en coup de sabre, “facial linear scleroderma”, and “morphea linearis”, combined with “treatment” or “therapy” were used as search terms. A total of 34 articles analyzed treatment outcomes for patients with localized scleroderma en coup de sabre including 4 retrospective cohort studies, 2 prospective cohort studies, 4 case series, and 24 case reports, representing a total of 69 patients (38 children and 31 adults). Methotrexate was the most commonly investigated treatment (26 patients) with a highest response rate (26/26, 100%). Other treatments included systemic glucocorticosteroids (nine patients), followed by UVA1 (four patients), mycophenolate mofetil (two patients), hydroxychloroquine (five patients), abatacept (two patients), tocilizumab (three patients), cyclosporine (one patient), interferon gamma (one patient), PUVA therapy (two patients), NB-UVB therapy (one patient), and pulsed dye laser (one patient). Reconstructive and surgery treatment was successfully used for lesions with settled disease activity to improve the cosmetic aspect of the lesions. Conclusion: methotrexate is the most often-studied treatment and reported good clinical outcomes in children and adults with localized scleroderma en coup de sabre.
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Hirt P, Paul S, Phuthongkam W, Schachner L. Morphea with Oral Mucosa Involvement and Unilateral Nevoid Telangiectasia as an Early Presentation of Morphea: A Case Report and Review of the Literature. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:38-40. [PMID: 32082471 PMCID: PMC7028378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Oral mucosal involvement in patients with morphea is quite rare. Unilateral nevoid telangiectasia is a rare vascular dermatosis characterized by unilateral telangiectasia distributed in a dermatomal pattern, especially on the upper trunk and extremities. We describe a case of a 10-year-old female patient that presents with morphea on her left chin and upper lip extending to the inner oral mucosa as well as a unilateral nevoid telangiectasia on her left cheek as an early presentation of localized scleroderma. This case is significant as it demonstrates a striking clinical presentation of morphea and an interesting early presentation of morphea as a unilateral nevoid telangiectasia that improved after treatment with oral methotrexate and prednisone.
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Affiliation(s)
- Penelope Hirt
- All authors are with the Department of Dermatology and Cutaneous Surgery at the University of Miami, Miller School of Medicine in Miami, Florida
- Dr. Phuthongkam is also with the Department of Pediatrics at the Faculty of Medicine Vajira Hospital at Navamindradhiraj University in Bangkok, Thailand
| | - Suchismita Paul
- All authors are with the Department of Dermatology and Cutaneous Surgery at the University of Miami, Miller School of Medicine in Miami, Florida
- Dr. Phuthongkam is also with the Department of Pediatrics at the Faculty of Medicine Vajira Hospital at Navamindradhiraj University in Bangkok, Thailand
| | - Weena Phuthongkam
- All authors are with the Department of Dermatology and Cutaneous Surgery at the University of Miami, Miller School of Medicine in Miami, Florida
- Dr. Phuthongkam is also with the Department of Pediatrics at the Faculty of Medicine Vajira Hospital at Navamindradhiraj University in Bangkok, Thailand
| | - Lawrence Schachner
- All authors are with the Department of Dermatology and Cutaneous Surgery at the University of Miami, Miller School of Medicine in Miami, Florida
- Dr. Phuthongkam is also with the Department of Pediatrics at the Faculty of Medicine Vajira Hospital at Navamindradhiraj University in Bangkok, Thailand
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Affiliation(s)
- Mildred Lopez Pineiro
- Department of Dermatology, University of Texas McGovern Medical School, Houston, Texas
| | - Kory Lee
- University of Texas McGovern Medical School, Houston, Texas
| | - Sarah Pinney
- Department of Dermatology, University of Texas McGovern Medical School, Houston, Texas
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Khamaganova I. Progressive Hemifacial Atrophy and Linear Scleroderma En Coup de Sabre: A Spectrum of the Same Disease? Front Med (Lausanne) 2018; 4:258. [PMID: 29445726 PMCID: PMC5798413 DOI: 10.3389/fmed.2017.00258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/26/2017] [Indexed: 11/25/2022] Open
Abstract
Similar clinical and histhopathological features in progressive hemifacial atrophy and linear scleroderma en coup de sabre are well known. Trauma may predispose to the development of both diseases. The lack of association with anti-Borrelia antibodies was shown in both cases as well. The otolaryngological and endocrine disorders may be associated findings in both diseases. However, there are certain differences in neurological and ophthalmological changes in the diseases.
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Affiliation(s)
- Irina Khamaganova
- Pirogov Russian National Research Medical University, Moscow, Russia
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