Morphea is a rare, chronic inflammatory condition that affects the skin and subcutaneous tissues with an unclear etiology. Genetic predisposition, autoimmune dysregulation, and environmental factors play a role in its pathogenesis. It affects both adults and children and presents as erythematous patches or plaques that develop sclerotic centers with a violaceous border. Early diagnosis and treatment are crucial to minimize damage and physical sequelae.

We present here a 30-year old female who presented with a solitary, violet-hue in color, indurated plaque on her left forearm after wearing a metal smartwatch for 4 months. She experienced on and off episodes of overheating from the watch but continued wearing it. There was no associated pruritus, tenderness, or loss of sensation. Anti-dsDNA showed a borderline positive result. Vitamin D levels were below the lower limit revealing a severe Vitamin D deficiency. Dermoscopy revealed fibrotic beams, branching vessels and an erythematous to pink background. Histopathologic analysis showed superficial and deep perivascular and periadnexal infiltrates of lymphocytes and plasma cells with compact collagen bundles and notable loss of periadnexal fat. The patient was started on topical halobetasol then shifted to tacrolimus 0.01% and started on targeted NB-UVB. Excellent response was seen after 9 sessions of phototherapy. There was a decrease in induration, size and no further progression.

Morphea is a rare inflammatory condition without a clear etiology and early diagnosis and treatment are important. This case highlights the relationship between gadget trauma and the development of Morphea.

Human ; Female ; Adult: 25-44 Yrs Old ; Morphea ; Scleroderma, Localized ; Trauma

Lupus erythematosus (LE) is an autoimmune disease that has a constellation of clinical manifestations from cutaneous to multi-organ systemic involvement. Childhood-onset SLE is an uncommon, lifelong autoimmune disease that is difficult to diagnose due to its multisystem involvement and multiplicity of clinical manifestations. In children, adolescent girls are most commonly affected with a peak incidence at about 12 years of age. Bullous Systemic Lupus Erythematosus (BSLE) is a rare manifestation of SLE with few cases described in childhood.

We report a case of a 6-year-old girl with an unrecalled history of chronic livedo re:cularis and a 3-month history of non-scarring alopecia who developed multiple minimally pruritic vesicles on the face and neck. The lesions increased in number, size, and distribution, becoming excoriated. The Nikolsky and Asboe-Hansen signs were negative. There was noted oral mucosal involvement and bilateral knee pain at rest with no joint swelling. A 3-mm skin punch biopsy of a vesicle from the upper back revealed an intraepidermal blister. Direct immunofluorescence of perilesional skin showed linear deposits of IgG (+2), C3 (+2), granular IgM (+2), Linear IgA and granular fibrinogen (+2) at the basement membrane zone, consistent with bullous systemic lupus erythematosus. ANA was positive at 1:160 (speckled pattern). We started the patient on dapsone 1.5 mg/kg/day. The patient was co-managed with Pediatric Rheumatology and oral prednisone at 2 mg/kg/day, hydroxychloroquine 50 mg once a day, mycophenolate mofetil 750 mg once a day and enalapril 5 mg once a day were prescribed. The lesions became dry and flat and healed without scarring with no new eruptions noted.

BSLE is uncommon in younger individuals. They usually present with a widespread symmetrical distribution of vesicular skin lesions and frequently favor the sun-exposed areas. We present here a rare case of BSLE in a young individual with an unusual histologic presentation. Treatment with dapsone, corticosteroids, hydroxychloroquine and mycophenolate mofetil afforded complete resolution in our case.

Human ; Female ; Child: 6-12 Yrs Old ; Child