Guttate Morphea in a 31-year-old Filipino female: A diagnostic challenge in its early stage
- Author:
Nadine Elizabeth V. Romano
1
;
Ruth B. Medel
1
;
Cindy Jao Tan
1
;
Camille B. Angeles
1
Author Information
- Publication Type:Journal Article
- Keywords: Guttate morphea; Cutaneous sclerosis
- MeSH: Scleroderma, Localized; Fibrosis
- From: Journal of the Philippine Medical Association 2024;102(2):89-94
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Morpheq, also known as localized
scleroderma, describes a distinctive inflammatory
skin disorder that ultimately leads to sclerosis. It is
differentiated from systemic scleroderma by the
absence of vasculopathy and organ involvement.
Initial erythema may precede the sclerotic stage by
a few months causing initial diagnostic confusion.
High index of suspicion and knowledge of disease
evolution are essential. We report a case of
morphea and its progression, the diagnostic
approach and the importance of early treatment
and long-term monitoring.
Case Summary:A 3l-year-old Filipino female who presented with multiple erythematous plagues on the trunk and extremities and arthralgia was initially diagnosed with cutaneous drug reaction. Prompt treatment led to partial relief of symptoms. However, two months later, eruption of multiple ivory-white small patches and plaques were noted on the same affected areas prompting an impression of morphea. Serum markers revealed elevated antinuclear antibody levels and negative anti-Scl70/anti-centromere serum autoantibodies. Skin biopsy showed homogenized thick dermal collagen bundles confirming the diagnosis of morphea. Topical therapy with calcipotriol + betamethasone dipropionate ointment showed remarkable improvement with decrease in erythema and softening of the lesions while adjunct narrowband-UVB phototherapy also provided relief due to its ability to reduce collagen synthesis and cytokine production.
Conclusion:Morphea may be easily misdiagnosed during the early stages especially if sclerosis ensues late in the disease. Characteristic clinical appearance of erythematous plaques with violaceous borders may not always be present. Histologic examination and serum autoantibodies help exclude other disorders with the same clinical and histopathological spectrum. Treatment is individualized depending on the severity and depth of skin involvement, early treatment and monitoring should be initiated before complications arise. - Full text:2024060416240465294Guttate Morphea.pdf
