Morphea

Two enlarging, dry, tender lesions had developed on the right breast of a 62-year-old woman 2 years before she sought medical consultation. The patient had no other symptoms; she was taking metoprolol succinate for cardiac arrhythmias.

Two indurated, well-defined plaques with a shiny surface were observed on the right breast. The lesions had a reddish pink border with a central yellow, “waxy” area. The plaques were firm; the linear lesion on the lateral aspect of the breast was tender when palpated.

The patient had applied various over-the-counter corticosteroid, antifungal, and lubricating creams, which failed to have any effect.

Dr Sean J. Murphy of Edgewater, Md, performed punch biopsies; histopathologic examination revealed atrophic epidermis with loss of epidermal appendages, superficial perivascular lymphoplasmacytic inflammation, and dermal collagen alteration consistent with localized scleroderma. These findings confirmed the suspected diagnosis of morphea.

The differential included lichen sclerosus et atrophicus, progressive systemic sclerosis, and a sclerotic plaque associated with Borrelia burgdorferi infection.

The cause of morphea is unknown. The disease is a variant of scleroderma that may be localized, as in this patient, or may occur in a more severe, generalized form. Active lesions can extend peripherally; inactive plaques may atrophy and become hyperpigmented. The active stage, which may last for 25 years,¹ is slowly progressive with occasional spontaneous remissions. There is no systemic involvement. There is no effective treatment for morphea, although topical and intralesional corticosteroids can be used to manage symptomatic skin thickening associated with the disease. For multiple active lesions, hydroxychloroquine sulfate may be tried.

REFERENCE:1. Habif TP. Clinical Dermatology: a Color Guide to Diagnosis and Therapy. 3rd ed. St Louis: Mosby–Year Book; 1996:560-561.