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Aragon Sierra AM, Hwang AS, Kechter J, Mangold AR, Nagaraja V, DiCaudo DJ. Systemic sclerosis with morphea-like plaques histopathologically mimicking cutaneous B-cell lymphoma. JAAD Case Rep 2024; 47:32-34. [PMID: 38576903 PMCID: PMC10993136 DOI: 10.1016/j.jdcr.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
| | - Angelina S Hwang
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Jacob Kechter
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Vivek Nagaraja
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
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2
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K S, Thakur V, Sethy M, Sahu DK, Behera B. Linear indurated plaque over the neck. Int J Dermatol 2024. [PMID: 38615334 DOI: 10.1111/ijd.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Isolated cutaneous swelling can have varied etiologies. The clinical diagnosis is usually difficult, and a correct diagnosis always requires a pathological examination. Hereby, we report a case of linear keloidal morphea on the neck of an 18-year-old male who presented with an asymptomatic, firm lesion for 6 months. Histopathological examination was consistent with morphea. This case highlights the uncommon form of morphea in an unusual location, which can be misdiagnosed for numerous neoplastic conditions and for which simple histopathological evaluation can clinch the diagnosis.
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Affiliation(s)
- Shreya K
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vishal Thakur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Madhusmita Sethy
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Deepak K Sahu
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Biswanath Behera
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
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Kreuter A, Moinzadeh P, Kinberger M, Horneff G, Worm M, Werner RN, Hammacher A, Krieg T, Wenzel J, Oeschger M, Weibel L, Müllegger R, Hunzelmann N. S2k guideline: Diagnosis and therapy of localized scleroderma. J Dtsch Dermatol Ges 2024; 22:605-620. [PMID: 38426689 DOI: 10.1111/ddg.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 03/02/2024]
Abstract
The updated S2k guideline deals with the diagnosis and therapy of localized scleroderma (LoS). LoS represents a spectrum of sclerotic skin diseases in which, depending on the subtype and localisation, structures such as adipose tissue, muscles, joints, and bones may also be affected. Involvement of internal organs or progression to systemic sclerosis does not occur. LoS can be classified into four main forms: limited, generalized, linear, and mixed forms, with some additional subtypes. For cases of limited skin involvement, the guideline primarily recommends therapy with topical corticosteroids. UV therapy can also be recommended. In subtypes with severe skin or musculoskeletal involvement, systemic therapy with methotrexate is recommended. During the active phase of the disease, systemic glucocorticosteroids can be used additionally. In cases of methotrexate and steroid refractory courses, contraindications, or intolerance, mycophenolate mofetil, mycophenolic acid, or abatacept can be considered as second-line systemic therapies. In the case of linear LoS, autologous adipose-derived stem cell transplantation can also be performed for correcting soft tissue defects.
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Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
- Department of Dermatology, Venereology and Allergology, Helios St. Johannes Hospital Duisburg, Duisburg, Germany
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Maria Kinberger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Gerd Horneff
- Department of General Pediatrics, Asklepios Hospital, St. Augustin, Germany
| | - Margitta Worm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany
| | - Ricardo N Werner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | | | - Thomas Krieg
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Jörg Wenzel
- Department of Dermatology and Allergology, University Bonn, Bonn, Germany
| | | | - Lisa Weibel
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Robert Müllegger
- Department of Dermatology and Venereology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
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Tokuchi K, Yanagi T, Inamura E, Kawamura T, Seo T, Fujita Y, Nakagawa M, Kasahara I, Matsuno Y, Ujiie H. Morphea-like subcutaneous panniculitis-like T-cell lymphoma. JAAD Case Rep 2024; 46:27-29. [PMID: 38510836 PMCID: PMC10950485 DOI: 10.1016/j.jdcr.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Affiliation(s)
- Keiko Tokuchi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Teruki Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Emi Inamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Kawamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Seo
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Fujita
- Department of Dermatology, Sapporo City General Hospital, Sapporo, Japan
| | - Masao Nakagawa
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ikumi Kasahara
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Sood S, Bagit A, Taghaddos D, King A, Maliyar K, Sachdeva M, Mufti A, Yeung J. Characteristics and management of sclerosing skin diseases during immune checkpoint inhibitor therapy: An evidence-based review. J Am Acad Dermatol 2024:S0190-9622(24)00507-3. [PMID: 38518957 DOI: 10.1016/j.jaad.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/20/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Taghaddos
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aliyah King
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Probity Medical Research, Waterloo, Ontario, Canada; Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.
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Yoshida K. Hemimasticatory spasm: a series of 17 cases and a comprehensive review of the literature. Front Neurol 2024; 15:1377289. [PMID: 38566853 PMCID: PMC10986637 DOI: 10.3389/fneur.2024.1377289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Hemimasticatory spasm (HMS) is a rare movement disorder characterized by paroxysmal spasms or twitches of the unilateral jaw-closing muscles. This study aimed to comprehensively evaluate the clinical features of patients with HMS. Data from 17 patients newly diagnosed with HMS (12 females and 5 males; mean age at onset: 46.7 years) who visited our department were retrospectively analyzed, and a literature search based on electronic medical databases from their inception until November 30, 2023, was conducted. A manual search was conducted for articles cited in the related literature. A total of 117 cases (72 females and 45 males; mean age at onset: 37.1 years) from 57 studies were analyzed. The muscles involved were the masseter (97.4%), temporalis (47.9%), and medial pterygoid (6%). Morphea or scleroderma was observed in 23.9% of the patients, and facial hemiatrophy in 27.4%. In 17.9% of the cases, Parry-Romberg syndrome was either complicated or suspected. Typical electromyographic findings included the absence of a silent period during spasms (23.9%) and irregular brief bursts of multiple motor unit potentials. Oral medicines, such as clonazepam or carbamazepine, alleviated the symptoms for some patients but were often unsatisfactory. Botulinum toxin therapy was effective in most cases. Recently, microvascular decompression surgery is increasingly being used, resulting in complete relief in some cases. In conclusion, highly effective modalities are currently available, and it is necessary to raise awareness of HMS to ensure that it can be diagnosed and treated accurately by both medical and dental professionals.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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O'Connor C, McCarthy S, Kiely L, McAuliffe MAP, Bennett M. Novel multispectral imaging to predict disease progression in pediatric morphea. Pediatr Dermatol 2024; 41:229-233. [PMID: 38305508 DOI: 10.1111/pde.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/07/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Morphea, or localized scleroderma, is an inflammatory, fibrosing skin disorder that can be progressive and debilitating. Infrared thermography frequently has false positive results. The aim of this study was to assess the ability of multispectral imaging to predict disease progression in children with morphea. METHODS Children with morphea were recruited between 2016 and 2022. Multispectral images of affected and matched contralateral unaffected sites were obtained using the Antera™ 3D camera. Clinical assessment was performed using the Localized Scleroderma Assessment Tool (LoSCAT). Children were followed up every 3 months for imaging and clinical review. The main outcome measurement was correlation of hemoglobin gradient between affected and matched contralateral unaffected tissue and progression. RESULTS Of 17 children, the average age was 12 years (range 6-18 years); most were female (76.5%) and white (94.1%). Nearly two-thirds (64.7%) had linear morphea, 35.2% had plaque morphea; 58.8% had been treated with systemic agents. The average LoSCAT score was 20.6 (range 5-73). The average hemoglobin gradient between affected and matched contralateral unaffected skin was four times higher in those who had progression (average differential 0.3, range 0.1-0.4) compared to those who did not (average differential 0.08, range 0.02-0.15). Using a cut off of a 0.18 hemoglobin gradient between affected and unaffected skin, the sensitivity of multispectral imaging for detecting progression in pediatric morphea is 90% with specificity of 100%. CONCLUSIONS Multispectral imaging is a novel assessment tool with promising accuracy in predicting progression as an adjunct to clinical assessment in pediatric morphea. Further research should examine its performance against thermography.
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Affiliation(s)
- Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Siobhan McCarthy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Lisa Kiely
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | | | - Mary Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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Yoshida K. Hemimasticatory Spasm Treated with Muscle Afferent Block Therapy and Occlusal Splint. J Mov Disord 2024:jmd.23249. [PMID: 38219737 DOI: 10.14802/jmd.23249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/13/2024] [Indexed: 01/16/2024] Open
Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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Venetsanopoulou AI, Mavridou K, Pelechas E, Voulgari PV, Drosos AA. Development of Morphea Following Treatment with an ADA Biosimilar: A Case Report. Curr Rheumatol Rev 2024; 20:CRR-EPUB-137311. [PMID: 38243962 DOI: 10.2174/0115733971266803231117072453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Tumor necrosis factor alpha (TNFα) is a pivotal cytokine involved in the pathogenesis of certain inflammatory diseases, such as rheumatoid arthritis (RA), spondyloarthropathies, and inflammatory bowel diseases. In the last two decades, TNFα inhibitors (TNFi) have revolutionized the treatment and outcome of the above disorders. However, the use of TNFi has been associated with the development of many autoimmune phenomena and paradoxical skin manifestations that may present as the same type of clinical indications for which the TNFi effectively used. Thus, they may display as arthritis, uveitis, colitis, psoriasis, and several other cutaneous clinical manifestations, among them the development of morphea, a localized scleroderma skin lesion. CASE PRESENTATION We describe a 58-year-old woman with seronegative RA, refractory to methotrexate, who was treated with ABP-501 (Hefiya), an adalimumab (ADA) biosimilar and developed an oval-shaped, deep skin lesion of approximately 3.5cm in size, affecting the left part of her back compatible with morphea 3 months after the initiation of therapy. ADA biosimilar was discontinued and two months later, she had substantial skin improvement. CONCLUSION This is the first report of morphea manifestation during TNFi biosimilar since the patient had no other trigger factors for morphea development like trauma and infections. Physicians dealing with patients treated with TNFi biosimilars should be aware of paradoxical skin reactions, among them morphea; thus, close monitoring, a minute and careful clinical examination, and a follow- up check are required.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Eleftherios Pelechas
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Keum H, Bermas B, Patel S, Jacobe HT, Chong BF. Patients with autoimmune skin diseases are at increased risk of adverse pregnancy outcomes. Am J Obstet Gynecol MFM 2024; 6:101226. [PMID: 37972926 DOI: 10.1016/j.ajogmf.2023.101226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Increased rates of adverse pregnancy outcomes have been reported in association with rheumatologic diseases such as systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis. However, little is known about pregnancy outcomes in patients with autoimmune skin diseases. OBJECTIVE This study aimed to determine the frequency of adverse pregnancy outcomes in patients with autoimmune skin diseases. We hypothesized that similar to rheumatic diseases, the rate of adverse pregnancy outcomes in patients with autoimmune skin diseases would be higher than the general population. STUDY DESIGN This is a case control study using the TriNetX US Collaborative Network, which is a database of electronic medical records of >95 million patients seen at 57 healthcare organizations in the United States. All pregnant women between the ages of 15 and 44 years who were seen at a healthcare organization between January 1, 2016 and December 31, 2021 were included. Participants with autoimmune skin disease were matched to healthy controls and controls with systemic rheumatologic conditions (systemic lupus erythematosus or rheumatoid arthritis). For both the autoimmune skin disease and healthy control groups, those with systemic rheumatologic condition or hidradenitis suppurativa were excluded. The primary outcomes were adverse pregnancy outcomes defined as spontaneous abortion, gestational hypertension, preeclampsia or eclampsia, gestational diabetes mellitus, intrauterine growth restriction, preterm premature rupture of membranes, preterm birth, and stillbirth. Patients with autoimmune skin diseases and controls were 1:1 propensity score-matched by age, race, ethnicity, comorbidities, obesity, and substance use. For each outcome, odds ratio with a 95% confidence interval was calculated. RESULTS A total of 2788 patients with autoimmune skin diseases were matched to 2788 healthy controls. Patients with autoimmune skin diseases were at a higher risk of spontaneous abortions than controls (odds ratio, 1.54; 95% confidence interval, 1.36-1.75; P<.001). Compared with patients with systemic lupus erythematosus, patients with autoimmune skin diseases were at lower risk of having infants with intrauterine growth restriction (odds ratio, 0.59; 95% confidence interval, 0.4-0.87; P=.01), preterm birth (odds ratio, 0.68; 95% confidence interval, 0.47-0.98; P=.04), and stillbirth (odds ratio, 0.50; 95% confidence interval, 0.25-0.97; P=.04). The differences in adverse pregnancy outcomes between patients with autoimmune skin diseases and those with rheumatoid arthritis were not statistically significant. CONCLUSION Patients with autoimmune skin diseases are at a higher risk of spontaneous abortions than patients without autoimmune skin diseases. When analyzed by each autoimmune skin disease, patients with cutaneous lupus erythematosus or vitiligo remained at increased risk of spontaneous abortions compared with patients without autoimmune skin diseases. Patients with autoimmune skin diseases have similar risks of adverse pregnancy outcomes as patients with rheumatoid arthritis, but lower risks than patients with systemic lupus erythematosus.
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Affiliation(s)
- Heejo Keum
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX (Ms Keum, Drs Jacobe and Chong)
| | - Bonnie Bermas
- Division of Rheumatology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX (Dr Bermas)
| | - Shivani Patel
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Dr Patel)
| | - Heidi T Jacobe
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX (Ms Keum, Drs Jacobe and Chong)
| | - Benjamin F Chong
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX (Ms Keum, Drs Jacobe and Chong).
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Akbaş A, Kılınç F, Hayran Y. A Comparison of Clinical, Demographic and Treatment Characteristics of Pediatric-Onset and Adult-Onset Patients Diagnosed With Localized Scleroderma. Dermatol Pract Concept 2024; 14:dpc.1401a23. [PMID: 38364378 PMCID: PMC10868915 DOI: 10.5826/dpc.1401a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Morphea localized scleroderma (LS) is a rare skin disease with unknown pathogenesis, which causes sclerosis of the dermis and subcutaneous tissue. OBJECTIVES It was aimed to compare the characteristics of patients with pediatric and adult-onset morphea. METHODS A retrospective analysis was performed on the records of 183 adult morphea patients. The demographics, clinical and laboratory characteristics, and treatment options of the patients were recorded. Adult patients with morphea over the age of 18 were divided into two groups according to the age of onset and compared. RESULTS Twenty-two percent (N = 41) of the patients had pediatric-onset morphea (POLS) and 77.6% (n=142) had adult-onset morphea (AOLS). While POLS had a higher head-neck involvement, AOLS had a higher breast involvement (P < 0.001 and P = 0.043). Patients with linear morphea were younger, and more frequently had at least one laboratory anomaly (P = 0.016 versus 0.024). Anti-dsDNA positivity and low hemoglobin (Hb) were observed more frequently in patients with breast involvement. Patients with inguinal involvement, on the other hand, had lower Hb and a higher rate of diabetes, and those patients were older (P = 0.042, 0.040, and 0.012, respectively). CONCLUSIONS Clinical characteristics and accompanying laboratory anomalies of the patients with morphea depend on the age of onset, involvement areas and the types of morphea, having such data readily available should guide the holistic approach for, and the monitoring process of, the disease.
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Affiliation(s)
- Ayşe Akbaş
- Ankara City Hospital, Dermatology, Ankara, Turkey
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12
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Go J, Wu YH. Generalized early inflammatory morphea mimicking interstitial T-cell lymphoma: A diagnostic pitfall. J Cutan Pathol 2024; 51:34-39. [PMID: 37596808 DOI: 10.1111/cup.14516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
Early generalized morphea can clinically mimic mycosis fungoides. The microscopic features of early inflammatory morphea may show variable degrees of infiltration and do not have the characteristic dermal collagen sclerosis. We report the case of a 63-year-old female patient who presented with a 2-month history of an asymptomatic skin rash. Physical examination revealed multiple erythematous to dusky patches on the trunk and thighs, resembling the patch stage of mycosis fungoides. Two skin biopsies were performed, both of which showed prominent interstitial lymphoid infiltration in the reticular dermis without dermal sclerosis. Small lymphocyte exocytosis and lining along the dermal-epidermal junction were observed focally in the epidermis. Small clusters of plasma cells and eosinophils were observed in perivascular areas. Although no predominant clonality was found for CD4 and CD8 stains, 50% loss of CD5 antigen and 90% loss of CD7 antigen expression were apparent in immunohistochemical studies. Subsequent blood tests showed a normal blood cell count and positive human T-lymphotropic virus Type 1 antibodies. The overall findings suggested interstitial mycosis fungoides or early adult T-cell lymphoma-leukemia. The patient refused aggressive treatment, and 3 months later, she presented with indurated plaques from the previous rash. A repeat biopsy revealed the typical features of morphea. This report discussed the pitfalls in the clinical and histopathological diagnosis of early generalized inflammatory morphea that both clinicians and pathologists should consider.
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Affiliation(s)
- Janelle Go
- Department of Dermatology, Region 1 Medical Center, Dagupan, Philippines
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Hung Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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13
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Ortega-Springall MF, Yang S, Mitra A, Fung MA. The Free Sign in morphea and other sclerosing disorders: A clue to the presence of early sclerosis? J Cutan Pathol 2024; 51:58-62. [PMID: 36975165 DOI: 10.1111/cup.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The Floating Sign is a histopathologic clue to the diagnosis of autoimmune sclerosing skin disorders such as morphea and interstitial granulomatous dermatitis (IGD). On the other hand, the "free-floating" sign has been associated with neoplasms, for example, dermatofibroma and interstitial mycosis fungoides. Herein, we report the Free Sign in sclerosing skin disorders. METHODS In a case-control study, we applied detailed histopathologic definitions of Floating Sign and Free Sign to assess their presence in morphea, IGD, and other sclerosing disorders. RESULTS Free Sign was present in most cases of morphea (46/55, 84%) and IGD (7/13, 54%) but not necrobiosis lipoidica (NL) (6/14, 42.8%) or sclerodermoid graft versus host disease (SGVHD) (2/7, 28.5%). The sensitivity and specificity of Free Sign for morphea versus other disorders was 84% and 56%, respectively. Floating Sign was not identified in most cases: NL (3/14, 21.4%), SGVHD (1/7, 14.2%), morphea (5/55, 9%), IGD (1/13, 7.7%). The diagnostic sensitivity of Floating Sign in morphea was 9%. CONCLUSIONS The Free Sign was present in most cases of morphea in our series and may represent a clue to the presence of evolving sclerosis. Free Sign may be seen in other sclerosing disorders. Technical artifact is a potential cause of a false-positive Free Sign.
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Affiliation(s)
| | - Sarah Yang
- Stanford-O'Connor Family Medicine Residency Program, San Jose, California, USA
| | - Anupam Mitra
- Department Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
| | - Maxwell A Fung
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
- Department Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
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14
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McClure E, Valaas L, Brandling-Bennett H. Morphea as an isotopic response to pigmented purpuric dermatosis and lichen striatus. Pediatr Dermatol 2024; 41:100-103. [PMID: 37495233 DOI: 10.1111/pde.15402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023]
Abstract
Morphea is an uncommon inflammatory and fibrosing disorder that has a polymorphous clinical presentation. We report two cases of morphea developing as an isotopic response after a preceding benign skin disease, accompanied by a review of the literature. This case series highlights the importance of return to care recommendations for benign skin conditions such lichen striatus and pigmented purpuric dermatoses due to the rare possibility of subsequent morphea development.
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Affiliation(s)
- Erin McClure
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Laura Valaas
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Heather Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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15
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Guo Q, Cen J, He M, Huang D, Tang Z, Xiong H. Fractional erbium:yttrium aluminum garnet laser in the treatment of morphea mouse model. J Cosmet Dermatol 2023; 22:3282-3290. [PMID: 37326004 DOI: 10.1111/jocd.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To assess the efficiency and the mechanism of fractional erbium:yttrium aluminum garnet (Er:YAG) laser for the treatment of morphea in mouse model. BACKGROUND Morphea is a rare autoimmune disease characterized by excessive collagen deposition in skin. Fractional Er:YAG laser treatment is a promising treatment to improve morphea, despite limited studies about the therapeutic effect and underlying mechanism. METHODS The mouse model of morphea was established by subcutaneously injecting with bleomycin (BLM). A total of 24 mice received fractional Er:YAG laser treatment once a week for 4 weeks. Objective measurement employed was ultrasonic imaging to measure dermal thickness. Subjective measures included scoring according to the adjusted Localized morphea Cutaneous Assessment Tool (LoSCAT); hematoxylin and eosin (H&E) staining to evaluate the histological grade of fibrosis; and quantitative morphometric studies to determine the expression of transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase-1 (MMP1) by immunohistochemistry. RESULTS In this self-controlled study, fractional Er:YAG laser treatment significantly ameliorate the severity of morphea, including lower clinical score (p < 0.01), decreased dermal thickness (p < 0.001), declined histological grade of fibrosis (p < 0.001), increased MMP1 (p < 0.001), and reduced TGF-β1 (p < 0.01) expression. CONCLUSIONS We found that fractional Er:YAG laser treatment of morphea has good clinical, ultrasonic, and histopathologic efficacy, which may be a promising treatment in the future.
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Affiliation(s)
- Qing Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junjie Cen
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingjie He
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Danqi Huang
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zengqi Tang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiong
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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16
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Shahin AB, Greene A, Reeder CB, Costello CM, Pittelkow MR, DiCaudo DJ. Paraneoplastic morphea with prominent mucin deposition. JAAD Case Rep 2023; 41:110-112. [PMID: 37920700 PMCID: PMC10618618 DOI: 10.1016/j.jdcr.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
| | - Adina Greene
- University of Arizona College of Medicine, Phoenix, Arizona
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Craig B. Reeder
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | - David J. DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
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17
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Bansal S, Chojer P, Kaur H, Poonia K. Bilateral en coup de sabre morphea in a male child: A rare presentation. Pediatr Dermatol 2023; 40:1152-1154. [PMID: 37316961 DOI: 10.1111/pde.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/13/2023] [Indexed: 06/16/2023]
Abstract
En coup de sabre is a rare subtype of morphea. Only a few bilateral cases have been reported to date. We report a case of a 12-year-old male child with two linear brownish depressed asymptomatic lesions over the forehead with hair loss on the scalp. After thorough clinical, ultrasonography and brain imaging, a diagnosis of bilateral en coup de sabre morphea was made and the patient was treated with oral steroids and weekly methotrexate.
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Affiliation(s)
- Shivani Bansal
- Department of Dermatology, AIIMS Bathinda, Punjab, India
| | - Parul Chojer
- Department of Dermatology, AIIMS Bathinda, Punjab, India
| | - Harmeet Kaur
- Department of Radiology, AIIMS Bathinda, Punjab, India
| | - Kavita Poonia
- Department of Dermatology, AIIMS Bathinda, Punjab, India
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18
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McColl J, Laxer RM, Pope E, Sibbald C. Evaluation of Methotrexate Intolerance in Children With Morphea. J Pediatr Pharmacol Ther 2023; 28:559-564. [PMID: 38130351 PMCID: PMC10731950 DOI: 10.5863/1551-6776-28.6.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Methotrexate is an immunosuppressant commonly used in dermatology. The prevalence of intolerance using the Methotrexate Intolerance Severity Score (MISS) in pediatric juvenile idiopathic arthritis (JIA) ranges from 25% to 75%, but studies in morphea patients are lacking. We sought to determine the prevalence and predictors of methotrexate intolerance in children with morphea compared with children with inflammatory skin diseases and JIA/uveitis. METHODS Eligible patients were ages 2 to 18 years and were taking methotrexate for at least 3 months to treat morphea, inflammatory skin disease, or uveitis/JIA. Methotrexate intolerance was calculated using the MISS. A 1-way analysis of variance compared absolute intolerance scores. Multivariate regression analysis was used to compare MISS across diseases and covariates. RESULTS Of 48 participants (mean ± SD age, 11.3 ± 4.1 years, 70.8% female), 15 had morphea, 16 had JIA/uveitis, and 17 had inflammatory skin diseases. The overall prevalence of intolerance was 20.8%. Age, sex, duration, and dose did not correlate with overall MISS. The MISS mean ± SD total for oral dosing was 2.5 ± 3.4, compared with 6.78 ± 6.8 for subcutaneous dosing. Patients with JIA/uveitis had the highest prevalence of intolerance (37.5%, n = 6), followed by morphea patients (20%, n = 3) and inflammatory skin disease patients (5.9%, n = 1). The OR of intolerance according to route of administration was 11.2 (95% CI, 2.03-61.89). CONCLUSIONS Methotrexate intolerance was highest among patients with JIA/uveitis. The only predictor for risk of intolerance was subcutaneous route of administration. Future work could examine disease activity correlations and interventions designed to minimize intolerance.
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Affiliation(s)
- Jeanine McColl
- Division of Rheumatology (JM, RML), Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronald M. Laxer
- Division of Rheumatology (JM, RML), Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elena Pope
- Division of Dermatology (EP, CS), Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Dermatology (EP, CS), Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
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19
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Helm M, Helm T, Helm K, Foulke G. Response to Jerjen et al's "Systemic sclerosis in adults. Part I: clinical features and pathogenesis". J Am Acad Dermatol 2023; 89:e171. [PMID: 37315804 DOI: 10.1016/j.jaad.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Matthew Helm
- Penn State Health Department of Dermatology, Hershey, Pennsylvania
| | - Thomas Helm
- Buffalo Medical Group, Williamsville, New York
| | - Klaus Helm
- Penn State Health Department of Dermatology, Hershey, Pennsylvania
| | - Galen Foulke
- Penn State Health Department of Dermatology, Hershey, Pennsylvania; Penn State Health Department of Public Health Sciences, Hershey, Pennsylvania.
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20
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Wortsman X, Vera-Kellet C. Ultrasound Morphea Activity Scoring (US-MAS): Modified US-MAS. J Ultrasound Med 2023; 42:2447-2450. [PMID: 37129178 DOI: 10.1002/jum.16247] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
Morphea, an autoimmune connective tissue disease that affects the skin, can be supported by color Doppler ultrasound in its diagnosis and assessment of activity. To date, there are no reliable laboratory parameters to track activity, and ultrasound presents a higher axial spatial resolution than magnetic resonance imaging and computed tomography, which is critical for studying the superficial layers. The quality of the ultrasonographic assessment of activity in morphea depends on the standardization and features of the acquisition of the anatomical data. We propose a detailed ultrasound morphea activity scoring called modified US-MAS (mUS-MAS) that could allow us to systematically register the cutaneous abnormalities in the corporal regions and their subregions. The selection of the scanning sites will depend on the corporal regions of involvement and their adjacent segments. Through systematic and sequential ultrasound data analysis, we propose that this scoring system can better support description and activity tracking accuracy.
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Affiliation(s)
- Ximena Wortsman
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
| | - Cristián Vera-Kellet
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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21
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Joly-Chevrier M, Gélinas A, Ghazal S, Moussa S, McCuaig CC, Piram M, Mereniuk A, Litvinov IV, Osman M, Pehr K, Netchiporouk E. Morphea, Eosinophilic Fasciitis and Cancer: A Scoping Review. Cancers (Basel) 2023; 15:4450. [PMID: 37760419 PMCID: PMC10526289 DOI: 10.3390/cancers15184450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Morphea is an autoimmune fibrotic skin disease. Eosinophilic fasciitis (EF) is considered to belong to the severe spectrum of morphea. We conducted a scoping review assessing the risk of secondary cancer among morphea/EF patients, paraneoplastic morphea/EF and morphea/EF developing secondary to cancer therapy. The search was conducted using MEDLINE, Embase, Cochrane databases for articles published from inception to September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines with no language or date restrictions. Two hundred and one studies were included. Of these, 32 studies reported on secondary cancer in morphea/EF patients, 45 on paraneoplastic morphea/EF and 125 on cancer-treatment-induced morphea/EF. While the current evidence remains limited, data suggest an increased risk of secondary cutaneous and possibly pancreatic malignancy in morphea patients, particularly the generalized subtype. There were insufficient data for EF. On the other hand, paraneoplastic morphea was anecdotal, whereas several observational studies suggested that ~10% of EF cases may be paraneoplastic, primarily in the context of hematologic malignancies. Radiotherapy-induced morphea is rare, seen in ~0.2% of treated patients and is usually localized to the treatment site, except in patients with pre-existing autoimmunity. While chemotherapy-induced cases are reported, immunotherapy morphea/EF cases are emerging and are preferentially seen with PD-1 and not CTLA-4 inhibitors. This study is limited by the type of articles included (case reports, case series and observational studies), and hence, additional research on this important topic is needed.
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Affiliation(s)
| | - Alexa Gélinas
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Stephanie Ghazal
- Division of Dermatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Sarah Moussa
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Catherine C. McCuaig
- Division of Pediatric Dermatology, Sainte-Justine Hospital, Montreal, QC H3T 1C5, Canada
| | - Maryam Piram
- Division of Pediatric Dermatology, Sainte-Justine Hospital, Montreal, QC H3T 1C5, Canada
| | - Alexandra Mereniuk
- Division of Dermatology, Sacre Coeur Hospital, Montreal, QC H4J 1C5, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Kevin Pehr
- Division of Dermatology, Jewish General Hospital, McGill University, Montreal, QC H3N 1V4, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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22
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Marathe M, Borkar S. Limited Cutaneous Scleroderma: A Case Report. Cureus 2023; 15:e45336. [PMID: 37849593 PMCID: PMC10577515 DOI: 10.7759/cureus.45336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Scleroderma is an uncommon disease that affects the connective tissue, causing skin hardening and sometimes organ damage. There are two main forms of scleroderma: localised scleroderma, or morphea, which usually has a mild and limited course and only affects the skin and/or the tissues below it, and systemic sclerosis, which involves skin hardening and internal organ problems. The cause of localised scleroderma is unknown. Recent studies suggest that this form can have different levels of severity and can affect some organs. To avoid complications due to the high morbidity of localised scleroderma, early treatment is recommended. In this article, we present the main aspects and details of the management of patients with localised scleroderma.
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Affiliation(s)
- Manvi Marathe
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shweta Borkar
- Internal Medicine, Datta Meghe Medical College, Nagpur, IND
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23
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Parra-Cares J, Wortsman X, Alfaro-Sepúlveda D, Mellado-Francisco G, Ramírez-Cornejo C, Vera-Kellet C. Color Doppler Ultrasound Assessment of Subclinical Activity With Scoring of Morphea. J Cutan Med Surg 2023; 27:454-460. [PMID: 37533149 DOI: 10.1177/12034754231191474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Detection of activity in morphea is paramount for adequately managing the disease. Subclinical ultrasound involvement on inactive lesions or healthy skin areas adjacent to morphea has not been described to date. OBJECTIVES The study aimed to detect morphea's subclinical activity by Color Doppler ultrasound not identified with the clinical scorings. MATERIALS & METHODS This cross-sectional retrospective study was done from January 2014 to July 2019 in patients with a clinicopathological diagnosis of morphea. The modified Localized Scleroderma Skin Severity Index (mLoSSI) and The Ultrasound Morphea Activity Score (US-MAS) were used to correlate clinical and subclinical activity. RESULTS A total of 36 patients met the inclusion criteria. 54% of cases presented subclinical activity in areas adjacent to the clinically active lesion, 23% in nonadjacent regions, and 23% demonstrated activity at a clinically inactive lesion site.100% of patients with morphea "en coup de sabre" involving the frontal region of the face concomitantly presented both subclinical activities of morphea on the frontal facial region and the scalp following the same axis.A positive relationship was observed between the degree of clinical activity measured by mLoSSI and US-MAS scoring.The main limitations of our study were the low number of patients and the inability to detect alterations < 0.1 mm. CONCLUSIONS Subclinical activity is frequent in morphea, can extend beyond the lesional areas, including apparently noninvolved adjacent and distant corporal regions, and can be detected by color Doppler ultrasound.
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Affiliation(s)
- Julio Parra-Cares
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ximena Wortsman
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Imaging, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
| | | | - Gonzalo Mellado-Francisco
- Department of Dermatology, Pontificia Universidad Católica de Chile, Connective Tissue Diseases Unit, Santiago, Chile
| | - Cristian Ramírez-Cornejo
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Vera-Kellet
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Dermatology, Pontificia Universidad Católica de Chile, Connective Tissue Diseases Unit, Santiago, Chile
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24
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Ma X, Huang J, Chen Y, Wang X, Long X. Bony Hyperplasia Beneath Atrophic Soft Tissue: A Rare Case of En Coup de Sabre and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2375-2379. [PMID: 37671405 PMCID: PMC10476651 DOI: 10.2147/ccid.s424231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
In this study, we report a rare case of en coup de sabre with hyperplasia of the left frontal bone beneath skin lesion, which is detected during magnetic resonance imaging screening and preoperative evaluation. A 27-year-old woman with 13-year history of progressive soft tissue depression in the forehead and scalp, and was treated by traditional Chinese herb before the disease went into stationary stage. The patient underwent serial long-pulsed laser treatments and autologous fat grafting with satisfactory outcome. To our knowledge, this is the first time that bony hyperplasia beneath the soft tissue lesion was found in a patient with en coup de sabre.
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Affiliation(s)
- Xuda Ma
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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25
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Sharma P, Khullar G, Nagia S, Sharma S. Clinical, histopathological and dermatoscopic overlap of lichen sclerosus and morphea in the same lesion. Australas J Dermatol 2023; 64:e292-e294. [PMID: 37229520 DOI: 10.1111/ajd.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 04/17/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Prateek Sharma
- Department of Dermatology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geeti Khullar
- Department of Dermatology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sonal Nagia
- Department of Dermatology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shruti Sharma
- Department of Health Research, National Institute of Pathology, ICMR, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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26
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Siskou S, Drongoula O, Grammatikopoulou J, Nivatsi P, Noukari D, Kokarida A, Chrysoglou CL, Chrysoglou SI, Vounotrypidis P, Demirtzoglou G, Goula M. Coexistence of Lichen Sclerosus Et Atrophicus and Morphea in the Same Lesion: A Case Report. Cureus 2023; 15:e43062. [PMID: 37680411 PMCID: PMC10481406 DOI: 10.7759/cureus.43062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Lichen sclerosus et atrophicus (LSA) is an inflammatory dermatosis of unknown etiology, usually affecting the genital region, with extragenital involvement being uncommon. The coexistence of LSA and morphea in the same lesion is rare. The present study aims to demonstrate that LSA and morphea might share similar pathologic processes. We present a case of a 53-year-old female patient with extragenital lesions with clinical appearance and histopathological features of both LSA and morphea. Finally, the two diseases might lie on the same disease spectrum.
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Affiliation(s)
- Styliani Siskou
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
| | - Ourania Drongoula
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
| | - Julia Grammatikopoulou
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
| | - Paraskevi Nivatsi
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
| | - Despina Noukari
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
| | - Aikaterini Kokarida
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
| | | | - Sofia-Ifigeneia Chrysoglou
- Laboratory of Medical Biology and Genetics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, GRC
| | | | - Georgios Demirtzoglou
- Department of Rheumatology, Attikon General University Hospital of Athens, Athens, GRC
| | - Maria Goula
- Department of Dermatology, State Hospital for Venereal and Skin Diseases, Thessaloniki, GRC
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27
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Coican A, Giansiracusa DM, Greenfield MF. En Coup de Sabre in a Pediatric Patient Treated With Calcipotriene. Cureus 2023; 15:e41459. [PMID: 37546139 PMCID: PMC10404129 DOI: 10.7759/cureus.41459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
En coup de sabre (ECDS) is a form of linear scleroderma or morphea that distinctly appears on the forehead and/or frontoparietal scalp. We report a case of a 6-year-old female that presented with a linear, hyperpigmented scar on her left forehead extending to her scalp with resultant alopecia and discoloration in the affected area. The patient was subsequently treated with topical calcipotriene ointment and had an excellent response with normalization of the sclerotic skin, hair regrowth, and improved hyperpigmentation. This report demonstrates that a conservative approach to treating pediatric patients with ECDS via calcipotriene ointment can be safe and effective.
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Affiliation(s)
- Alexis Coican
- Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | | | - Melinda F Greenfield
- Dermatology, Advanced Dermatology and Cosmetic Surgery - Ponte Vedra, Ponte Vedra Beach, USA
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28
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Khorasanizadeh F, Kalantari Y, Etesami I. Role of imaging in morphea assessment: A review of the literature. Skin Res Technol 2023; 29:e13410. [PMID: 37522502 PMCID: PMC10318382 DOI: 10.1111/srt.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Localized scleroderma, known as morphea, is a connective tissue disorder characterized by inflammation and fibrosis of the skin and the soft tissue. There exist no universally accepted validated outcome measures in order to monitor the disease activity. Besides clinical scores to evaluate outcome measures, imaging modalities are increasingly utilized in assessing patients with morphea, such as high-frequency ultrasonography (US), shear-wave elastography (SWE), and magnetic resonance imaging (MRI). However, the accuracy of these imaging modalities in monitoring morphea activity is not yet clear. AIMS To review the literature regarding the role of imaging modalities in assessing patients with morphea. MATERIALS & METHODS In this study, we searched the PubMed/Medline database for articles published from inception until February 2023. RESULTS A total number of 23 original articles in three categories of US, elastography, and MRI were included. DISCUSSION Regarding US, criteria, including increased dermal thickness, increased echogenicity of the subcutaneous tissue, and decreased dermal echogenicity, were indicators of active morphea lesions when using high frequencies probe (18-20 MHz) color Doppler sonography. Moreover, studies evaluating SWE, a novel method to quantitatively assess tissue stiffness, demonstrated increased dermal stiffness in active lesions. CONCLUSION Studies showed that MRI can help to determine the depth of disease, particularly as a first-line and follow-up diagnostic tool, especially in generalized and deep morphea. In addition, brain MRI may be useful for patients with localized craniofacial scleroderma experiencing new or worsening neurological symptoms.
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Affiliation(s)
| | - Yasamin Kalantari
- Department of DermatologyRazi HospitalTehran University of Medical SciencesTehranIran
| | - Ifa Etesami
- Department of DermatologyRazi HospitalTehran University of Medical SciencesTehranIran
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Foeldvari I, Marrani E. Systemic therapy in juvenile localized scleroderma. Expert Rev Clin Immunol 2023; 19:1225-1238. [PMID: 37462119 DOI: 10.1080/1744666x.2023.2237685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Juvenile localized scleroderma (JLS) is a rare sclerosing disorder of childhood which can result in permanent morbidity and functional disability, if not effectively treated. Treatment should be started in the inflammatory phase before the development of any complication and/or damage. AREAS COVERED In this review, we will discuss how to assess disease activity and damage in JLS, and propose an escalation plan for systemic treatment, according to a treat-to-target concept. We will discuss the definition of inactive disease and how and when to discontinue medications. EXPERT OPINION Before starting treatment, it is extremely important to assess baseline disease activity for treatment response to be adequately checked. Moreover, the activity of the extra cutaneous involvement is an important part of the assessment. Patients should be treated in the 'therapeutic window,' before significant fibrosis results. Most patients should receive systemic treatments; in these patients, Methotrexate should be used as the first-line disease-modifying anti-rheumatic drug (DMARD). However, methotrexate intolerance or non-response is an issue, and these patients should be proposed a treatment escalation according to results of latest studies. Future research can develop better prognostic markers to help to guide our decision.
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Affiliation(s)
- Ivan Foeldvari
- Hamburger Zentrum Für Kinder- Und Jugendrheumatologie, Hamburg, Germany
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Ng AT, Brandling-Bennett HA, Drolet BA, Siegel DH, Chiu YE. Presenting characteristics and progression of pediatric-onset morphea: Interim analysis of a prospective registry. Pediatr Dermatol 2023. [PMID: 37317938 DOI: 10.1111/pde.15350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 04/29/2023] [Indexed: 06/16/2023]
Abstract
Morphea is a rare fibrosing disorder with a highly variable disease course, which can complicate management. Here, we present a prospective cohort study describing the current treatments used in the management of pediatric-onset morphea and assessing responses to systemic and topical therapies. Most patients demonstrated inactive disease by 1 year, regardless of treatment, though recurrences were common in our cohort overall (39%). Our results support the need for continuous monitoring of all children with morphea following the completion of treatment, including topical treatment, due to high rates of disease relapse.
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Affiliation(s)
- Ashley T Ng
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heather A Brandling-Bennett
- Department of Pediatrics and Dermatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Beth A Drolet
- Departments of Dermatology and Pediatrics, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Dawn H Siegel
- Departments of Dermatology and Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Mercuri SR, Di Nicola MR, Bianchi VG, Paolino G. Adult-Onset Linear Morphea ( en coupe de sabre) of the Face Successfully Treated with Photoactivated Low-Temperature Platelet-Rich Plasma: A Valid Therapeutic Option. Medicina (Kaunas) 2023; 59:1114. [PMID: 37374318 DOI: 10.3390/medicina59061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Localized scleroderma (also known as morphea) is a chronic autoimmune disorder characterized by depressed, fibrotic, and dyschromic cutaneous lesions. It has a significant impact on the patient's daily life due to the unaesthetic evolution of the cutaneous lesions. Morphea is clinically divided into linear, circumscribed (plaque), generalized, pansclerotic, and mixed forms. Linear morphea en coupe de sabre (LM) usually arises in childhood. However, in about 32% of cases, it may arise in adulthood, showing a more aggressive course with also an increased risk of systemic involvement. Methotrexate is the first-line treatment for LM, although systemic steroids, topical agents (corticosteroids and calcineurin inhibitors), hyaluronic acid injections, and hydroxychloroquine or mycophenolate mofetil are valid therapeutic options. In any case, these treatments are not always effective and sometimes can be associated with important side effects and/or not tolerated by the patients. In this spectrum, platelet-rich plasma (PRP) injection can be considered a valid and safe alternative since PRP injections in the skin induce the release of anti-inflammatory cytokines and growth factors, thus reducing inflammation and increasing collagen remodeling. Herein, we describe a successful treatment of an adult-onset LM en coupe de sabre with photoactivated low-temperature PRP (Meta Cell Technology Plasma) sessions, showing an important local improvement of the lesion and patient satisfaction.
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Affiliation(s)
- Santo Raffaele Mercuri
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, 20132 Milan, Italy
- Medicine and Surgery Faculty, San Raffaele Vita-Salute University, 20132 Milan, Italy
| | | | | | - Giovanni Paolino
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, 20132 Milan, Italy
- Medicine and Surgery Faculty, San Raffaele Vita-Salute University, 20132 Milan, Italy
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Werner G, Sanyal A, Mirizio E, Hutchins T, Tabib T, Lafyatis R, Jacobe H, Torok KS. Single-Cell Transcriptome Analysis Identifies Subclusters with Inflammatory Fibroblast Responses in Localized Scleroderma. Int J Mol Sci 2023; 24:9796. [PMID: 37372943 DOI: 10.3390/ijms24129796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/19/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Localized scleroderma (LS) is an autoimmune disease with both inflammatory and fibrotic components causing an abnormal deposition of collagen in the skin and underlying tissue, often leading to disfigurement and disability. Much of its pathophysiology is extrapolated from systemic sclerosis (SSc) since the histopathology findings in the skin are nearly identical. However, LS is critically understudied. Single-cell RNA sequencing (scRNA seq) technology provides a novel way to obtain detailed information at the individual cellular level, overcoming this barrier. Here, we analyzed the affected skin of 14 patients with LS (pediatric and adult) and 14 healthy controls. Fibroblast populations were the focus, since they are the main drivers of fibrosis in SSc. We identified 12 fibroblast subclusters in LS, which overall had an inflammatory gene expression (IFN and HLA-associated genes). A myofibroblast-like cluster (SFRP4/PRSS23) was more prevalent in LS subjects and shared many upregulated genes expressed in SSc-associated myofibroblasts, though it also had strong expression of CXCL9/10/11, known CXCR3 ligands. A CXCL2/IRF1 cluster identified was unique to LS, with a robust inflammatory gene signature, including IL-6, and according to cell communication analysis are influenced by macrophages. In summary, potential disease-propagating fibroblasts and associated gene signatures were identified in LS skin via scRNA seq.
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Affiliation(s)
- Giffin Werner
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Anwesha Sanyal
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Emily Mirizio
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Theresa Hutchins
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Tracy Tabib
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Kathryn S Torok
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
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Wen X, Chen F, Wang L. Stiff skin syndrome: a clinicopathological study of 31 cases. Eur J Dermatol 2023; 33:235-240. [PMID: 37594328 DOI: 10.1684/ejd.2023.4477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Stiff skin syndrome (SSS) is a rare disease characterized by sclerosis of the skin. Cases of both widespread and segmental SSS have been reported. OBJECTIVES To report the clinical and histopathological characteristics of a large series of SSS. MATERIALS & METHODS We retrospectively analysed the clinical and histopathological characteristics of widespread and segmental SSS collected from a dermatology department. We also compared histopathology between segmental SSS and morphea. RESULTS Thirty-one cases, including three widespread SSS and 28 segmental SSS, were collected. Skin lesions of widespread SSS generally showed skin sclerosis concentrating over the lumbar, buttocks, thighs, proximal part of limbs, and shoulders with specific abnormal gait and posture. Skin lesions of segmental SSS generally showed sclerotic plaques involving the thigh, lumbar area and buttocks, associated with hypertrichosis, hyperpigmentation and a cobblestone appearance. Segmental SSS did not typically cause joint limitation or serious physical discomfort. Histopathologically, SSS showed proliferation of fibroblasts and sclerosis of collagen in the dermis or subcutaneous tissue. Compared with morphea, SSS showed more prominent proliferation of fibroblasts and completely lacked lymphocyte infiltration. CONCLUSION Segmental SSS represents the major variant of SSS. Histopathologically, SSS shows proliferation of fibroblasts, sclerosis and an absence of inflammation.
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Affiliation(s)
- Xuhong Wen
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No.127 of Changlexi Road, Xian 710032, China, Department of Dermatology, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Fengming Chen
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No.127 of Changlexi Road, Xian 710032, China
| | - Lei Wang
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No.127 of Changlexi Road, Xian 710032, China
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Ronen S, Ramot Y, Zlotogorski A, Shreberk-Hassidim R. Efficacy of ultraviolet A1 phototherapy for inflammatory, sclerotic and neoplastic dermatological diseases: A 10-year tertiary referral center experience. Photodermatol Photoimmunol Photomed 2023; 39:256-262. [PMID: 36052749 DOI: 10.1111/phpp.12833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/13/2022] [Accepted: 08/30/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Ultraviolet (UV) A1 phototherapy is considered a beneficial treatment for various inflammatory, sclerotic, malignant, and other skin conditions. However, the available data regarding its efficacy for different indications, the potential side effects, and the recommended treatment protocols are sparse. OBJECTIVES To assess the efficacy of UVA1 phototherapy and identify correlation between different indications and treatment protocols to response rates. METHODS We performed a retrospective study of a cohort of 335 patients treated with UVA1 phototherapy at the Department of Dermatology at Hadassah Medical Center, Jerusalem, Israel, between 2008 and 2018. RESULTS The study population included 163 patients with inflammatory diseases (mainly atopic dermatitis and other types of eczema), 67 patients with sclerotic diseases (morphea and graft versus host disease), nine patients with neoplastic diseases (cutaneous T cell lymphoma), and 188 patients with other cutaneous disorders. Response rates ranged between 85% and 89% across indications, without differences in response rates among the indication groups (p = .941). In a multivariant logistic regression model, increased number of treatments and higher maximal dosages were associated with response to treatment (p < .001). Using ROC analysis, a cut-off of 8 UVA1 phototherapy treatments was chosen as predictive for beneficial response (86.4% sensitivity, 78% specificity). A cut-off of 40 J/cm2 was chosen as an optimal maximal dosage for differentiating between responders and non-responders (51.1% sensitivity, 83.1% specificity). CONCLUSIONS UVA1 phototherapy is an effective treatment for a variety of skin conditions. In most patients, at least eight treatments of a medium-high dosage are required for clinical response.
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Affiliation(s)
- Shachar Ronen
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Ramot
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | - Abraham Zlotogorski
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | - Rony Shreberk-Hassidim
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
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35
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Elinkichari D, Tabka M, Souissi A, Alaoui F, Chelly I, Haouet S, Mokni M. Localized scleroderma with pulmonary arterial hypertension and pulmonary interstitial fibrosis in a patient with positive Th/to antibodies: Case report and review of literature. Clin Case Rep 2023; 11:e7183. [PMID: 37207083 PMCID: PMC10188899 DOI: 10.1002/ccr3.7183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 05/21/2023] Open
Abstract
Morphea is an auto-immune disease, and its association with other immune-mediated diseases should not come as a surprise. Dermatologists should be aware of its possible coexistence with severe systemic involvement.
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Affiliation(s)
- Dorsaf Elinkichari
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Mariem Tabka
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Asmahane Souissi
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Fatimazahra Alaoui
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Ines Chelly
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Slim Haouet
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Mourad Mokni
- Department of DermatologyLa Rabta HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
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36
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Romagnuolo M, Moltrasio C, Marzano AV, Nazzaro G, Muratori S, Recalcati S. Intramuscular Polydeoxyribonucleotides in Fibrotic and Atrophic Localized Scleroderma: An Explorative Prospective Cohort Study. Biomedicines 2023; 11:biomedicines11041190. [PMID: 37189808 DOI: 10.3390/biomedicines11041190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Effective options in the quiescent, scantily inflammatory phase of localized scleroderma (morphea) are lacking. A cohort study in patients with histologically confirmed fibroatrophic morphea explored the therapeutic value of the anti-dystrophic A2A adenosine agonist polydeoxyribonucleotide (PDRN, one daily 5.625 mg/3 mL ampoule for 90 days with a three-month follow-up). Primary efficacy endpoints: Localized Scleroderma Cutaneous Assessment Tool mLoSSI and mLoSDI subscores for disease activity and damage in eighteen areas; Physicians Global Assessment for Activity (PGA-A) and Damage (PGA-D) VAS scores; skin echography. Secondary efficacy endpoints: mLoSSI, mLoSDI, PGA-A, PGA-D, and morphea areas (photographs) over time; Dermatology Life Quality Index (DLQI); skin biopsy scores and induration over time. Twenty-five patients enrolled; 20 completed the follow-up period. Highly significant improvements at the end of the 3-month treatment period: mLoSSI-73.7%, mLoSDI-43.9%, PGA-A-60.4%, PGA-D-40.3%, with further improvements at follow-up visit for all disease activity and damage indexes. Overall, the outcomes suggest that a daily PDRN ampoule intramuscularly for 90 days reduces disease activity and damage rapidly and significantly in quiescent, modestly inflammatory morphea with few currently therapeutic options. The COVID-19 pandemic and lockdowns caused difficulties in enrollment, and some patients were lost to follow-up. Due to low final enrollment, the study outcomes may have only an exploratory value, yet they appear impressive. The anti-dystrophic potential of the PDRN A2A adenosine agonist deserves further in-depth exploration.
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Affiliation(s)
- Maurizio Romagnuolo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Simona Muratori
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Alhayaza R, Alhayaza G, Algarni A, Alhumidi A, AlHarithy R. Generalized morphea following COVID-19 vaccine: Case report and literature review. Clin Case Rep 2023; 11:e7133. [PMID: 37006851 PMCID: PMC10062313 DOI: 10.1002/ccr3.7133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Physicians should be vigilant for COVID-19 vaccine side effects and investigate any associated cutaneous manifestations. This will ultimately facilitate better understanding and recognition of various skin reactions related to the vaccine.
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Affiliation(s)
- Raid Alhayaza
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - Ghada Alhayaza
- Department of Dermatology and Dermatologic SurgeryPrince Sultan Military Medical CityRiyadhSaudi Arabia
| | - Abdullah Algarni
- Department of DermatologyKing Saud Medical CityRiyadhSaudi Arabia
| | - Ahmed Alhumidi
- Department of PathologyKing Saud UniversityRiyadhSaudi Arabia
| | - Ruaa AlHarithy
- College of MedicinePrincess Nourah Bint Abdulrahman UniversityRiyadhSaudi Arabia
- Department of DermatologySecurity Forces HospitalRiyadhSaudi Arabia
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38
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Yu B, Kim SR, Roy SF, Girardi M. A rare presentation of cutaneous T-cell lymphoma mimicking morphea. JAAD Case Rep 2023; 33:59-61. [PMID: 36860808 PMCID: PMC9969200 DOI: 10.1016/j.jdcr.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Beverly Yu
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Sa Rang Kim
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Simon F. Roy
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
- Correspondence to: Michael Girardi, MD, Department of Dermatology, Yale School of Medicine, PO Box 208059, 333 Cedar St, New Haven, CT 06520.
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39
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Zhang F, Li J, Zhao Q, Liu H, Zhang F. Study about evaluation of efficacy of methotrexate in localized scleroderma using ultrasonography. Skin Res Technol 2023; 29:e13300. [PMID: 36973989 PMCID: PMC10155795 DOI: 10.1111/srt.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The treatment and curative effect evaluation of localized scleroderma (LS) still perplexes many clinical workers. PURPOSE To investigate the efficiacy of methotrexate in the treatment of LS by the evaluation of ultrasonography. METHODS A prospective study enrolled 10 patients treated with MTX for at least 6 months was conducted. Treatment outcome was evaluated by a clinical score and 15-MHz ultrasonography. Safety assessment included the monitoring of adverse drug reactions and clinical laboratory examinations. RESULTS Eight of the 10 patients achieved clinical remission only with MTX. One patient was relieved after MTX combined with corticosteroids, while another one does not improve after the treatment of mycophenolate mofetil and corticosteroids. The effective rate of MTX is 80%. Nine patients were significantly improved with a decrease of the Localized Scleroderma Cutaneous Assessment Tool (the mean score of the LoSCAT cutaneous activity dropped from 5.2 to 1.0, p < 0.001, the mean score of the LS cutaneous damage dropped from 4.3 to 2.3, p = 0.002). The average difference of thickness between skin lesions and normal skin evaluated by ultrasonography decreased from 0.13 cm to 0.04 cm (p = 0.009) in eight patients. No serious adverse reactions occurred. CONCLUSION Methotrexate is a safe and effective treatment for patients with LS. Ultrasonography can be considered as an efficient assessment tool for evaluation LS.
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Affiliation(s)
- Fan Zhang
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Jianke Li
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Qing Zhao
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology and Provincial Hospital for Skin DiseasesShandong First Medical University and Shandong Academy of Medical ScienceJinanChina
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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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Macklin M, Yadav S, Jan R, Reid P. Checkpoint Inhibitor-Associated Scleroderma and Scleroderma Mimics. Pharmaceuticals (Basel) 2023; 16:259. [PMID: 37259404 PMCID: PMC9962184 DOI: 10.3390/ph16020259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 10/28/2023] Open
Abstract
Immune checkpoint inhibitors (ICI) are the standard of care for various malignancies and have been associated with a wide spectrum of complications that are phenotypically akin to primary autoimmune diseases. While the literature on these toxicities is growing, there is a paucity of data regarding ICI-associated scleroderma which can carry significant morbidity and limit the ability to continue effective ICI therapy. Our review aimed to analyze the current literature on ICI-associated systemic scleroderma (ICI-SSc) and key scleroderma mimics. Cases of ICI-SSc had notable differences from primary SSc, such as fewer vascular features and less seropositivity (such as scleroderma-specific antibodies and antinuclear antibodies). We found that patients with a diagnosis of SSc prior to the start of ICI can also experience flares of pre-existing disease after ICI treatment used for their cancer. Regarding scleroderma mimics, several cases of ICI-eosinophilic fasciitis have also been described with variable clinical presentations and courses. We found no cases of scleroderma mimics: ICI-scleromyxedema or ICI-scleroedema. There is a critical need for multi-institutional efforts to collaborate on developing a patient database and conducting robust, prospective research on ICI-scleroderma. This will ultimately facilitate more effective clinical evaluations and management for ICI-scleroderma.
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Affiliation(s)
- Michael Macklin
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Sudeep Yadav
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Reem Jan
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Pankti Reid
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago Medical Center, Chicago, IL 60637, USA
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Daruish M, Zidan A, Greenblatt DT, Stefanato CM. Loss of CD34 Expression within an Interstitial Dermal Lymphoid Cell Infiltrate Is a Helpful Clue to the Diagnosis of Morphea. Dermatopathology (Basel) 2023; 10:70-74. [PMID: 36810568 PMCID: PMC9944576 DOI: 10.3390/dermatopathology10010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
A dermal interstitial lymphocytic infiltrate may represent a diagnostic challenge, particularly if the clinical history is not provided. We present three cases within the histological spectrum of morphea in which the immunohistochemical marker CD34 was helpful in confirming the diagnosis.
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Affiliation(s)
- Maged Daruish
- Department of Dermatopathology, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Anoud Zidan
- Department of Dermatopathology, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Danielle T. Greenblatt
- Pediatric Dermatology, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Catherine M. Stefanato
- Department of Dermatopathology, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Correspondence:
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Shin L, Smith J, Shiu J, Kraus CN, Elsensohn AN. Association of lichen sclerosus and morphea with immune checkpoint therapy: a systematic review. Int J Womens Dermatol 2023; 9:e070. [PMID: 36700160 DOI: 10.1097/JW9.0000000000000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/22/2022] [Indexed: 01/27/2023] Open
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Kantor J. This Month in JAAD International: January 2023: Toward a more inclusive vision of cosmetic surgery. J Am Acad Dermatol 2023; 88:26. [PMID: 36370902 DOI: 10.1016/j.jaad.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan Kantor
- Department of Dermatology, Center for Global Health, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Florida Center for Dermatology, St Augustine, Florida.
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Abbas LF, Joseph AK, Day J, Cole NA, Hallac R, Derderian C, Jacobe HT. Measuring asymmetry in facial morphea via 3-dimensional stereophotogrammetry. J Am Acad Dermatol 2023; 88:101-108. [PMID: 35643243 DOI: 10.1016/j.jaad.2022.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Objectively determining tissue loss in craniofacial morphea is challenging. However, 3-dimensional (3D) stereophotogrammetry is a noninvasive modality that may be a useful adjunct. OBJECTIVE To prospectively evaluate 3D stereophotogrammetry in the assessment of craniofacial linear morphea. METHODS Participants underwent clinical, quality-of-life, and 3D-stereophotogrammetry assessments. Traditional photographs and 3D-stereophotogrammetry images were rated as mild, moderate, or severe by 2 experts and 2 nonexperts. In addition, interrater and intrarater reliability (on delayed rescoring) were calculated. RESULTS Of 23 patients with craniofacial morphea, 3D stereophotogrammetry detected pathologic asymmetry in 14 (20.6%) patients. Providers rated patients as more severely affected when using 3D stereophotogrammetry versus when using traditional photographs (19% severe on 3D stereophotogrammetry vs 0% severe on traditional photographs, P = .004). Qualitative ratings of both traditional and 3D images showed high inter- and intrarater reliability between experts and nonexperts alike. Physicians' Global Assessment of Damage scores correlated with mouth asymmetry (P = .0021), cheek asymmetry (P = .04), and 3D-stereophotogrammetry ratings (median, mild: 27.5 vs moderate: 46.5 vs severe: 64, P = .0152). Lower face asymmetry correlated with worse quality-of-life scores (P = .013). LIMITATIONS Small sample size and cross-sectional design. CONCLUSION 3D stereophotogrammetry can reliably detect and quantify asymmetry in craniofacial morphea with greater sensitivity than that observed with traditional assessment alone. 3D stereophotogrammetry may be a useful adjunct to clinical examination.
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Affiliation(s)
- Laila F Abbas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adrienne K Joseph
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennifer Day
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Naomi A Cole
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rami Hallac
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher Derderian
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi T Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Hobbs LK, Kozak MD, Gru AA. Sclerodermiform Lupus Erythematosus: A Series of Five Patients. J Clin Aesthet Dermatol 2023; 16:25-29. [PMID: 36743969 PMCID: PMC9891210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Sclerodermiform lupus erythematosus (SDLE) is a rare Type 3 overlap syndrome of morphea and cutaneous lupus diagnosed with histopathologic features of both diseases present. It was first reported in 1976 by Umbert et al with a case series of four patients. SDLE is more common in young to middle-aged female patients. Methods After IRB approval, we searched our internal pathology database for cases of SDLE, excluded any patients that did not fulfill the diagnostic criteria, and verified each case with a board-certified dermatopathologist. Results Five patients with SDLE were identified; three of the patients are male and three are Black. Consistent with prior reports in the literature, the lesions were described as hyperpigmented plaques or nodules. The most commonly involved location was the extremities. Histopathology showed diffuse sclerosis in all five patients' biopsies, vacuolar interface changes in three biopsies, basement membrane thickening in one biopsy, and increased dermal mucin deposition in two of the four biopsy specimens stained with colloidal iron. Improvement was noted in patients treated with topical, intralesional, or systemic corticosteroids, topical calcineurin inhibitors, and oral antimalarials. Conclusion We describe five cases of SDLE which is the largest series to date and the first series with a majority of patients being male. Improved recognition and a more thorough understanding of SDLE is necessary for appropriate diagnosis and management.
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Koneru V, Ondo WG. Facial Myokymia and Hemimasticatory Spasm with Linear Focal Alopecia. Mov Disord Clin Pract 2023; 10:143-144. [PMID: 36988999 PMCID: PMC9847297 DOI: 10.1002/mdc3.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Vindhya Koneru
- Department of NeurologyHouston Methodist Hospital6560 Fannin, Ste 1002HoustonTexas77030USA
| | - William G. Ondo
- Houston Methodist Neurological Institute, and Weill Cornell Medical College6560 Fannin, Ste 1002HoustonTexas77030USA
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Darkase BA, Ratnaprkhi T, Bhatt K, Khopkar U. Unusual cutaneous manifestations of dracunculiasis: Two rare case reports. Indian J Dermatol Venereol Leprol 2023; 89:237-240. [PMID: 33969654 DOI: 10.25259/ijdvl_909_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Abstract
A nematode parasite, Dracunculus medinensis, causes dracunculiasis. Despite being non-fatal, this condition causes significant morbidity. Dracunculiasis is considered an eradicated disease in India since 1999. We report two cases that document the unusual linear morphea-like morphology of the calcified D. medinensis and the rare periorbital location of the worm. The cases presented here are rare and a diagnostic challenge, considering the eradicated status of dracunculiasis.
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Affiliation(s)
| | | | - Kalpana Bhatt
- UBM Institute and Dr. Bhatt Sonography Centre, Maharashtra, India
| | - Uday Khopkar
- Department of Dermatology, KEM Hospital, Mumbai, Maharashtra, India
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Myszkowska-Torz A, Tomaszewski M, Kotowski M, Witczak C, Figlerowicz M, Mazur-Melewska K. Cutaneous Manifestations of Lyme Borreliosis in Children-A Case Series and Review. Life (Basel) 2022; 13:life13010072. [PMID: 36676022 PMCID: PMC9864164 DOI: 10.3390/life13010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
The occurrence of skin lesions is the earliest symptom of Lyme disease, and the diagnosis of these lesions and appropriate treatment may prevent complications of the disease, which are mainly neurological. The cutaneous presentation in borreliosis is heterogeneous. There are typical lesions that constitute the basis for the diagnosis of Lyme disease, and atypical ones, which cause significant diagnostic difficulties especially when the patient does not remember the tick bite. This study aims to describe the heterogeneous skin symptoms of Lyme borreliosis, as well as offer a practical approach for the recognition of the disease. Based on pediatric cases from clinical practice, rare cutaneous presentations of Lyme disease at various stages of illness and therapy are presented. Diagnostic recommendations for recognizing individual forms are discussed.
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Affiliation(s)
- Agnieszka Myszkowska-Torz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Mateusz Tomaszewski
- Department of Orthodontics and Temporomanidbular Disorders, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Michał Kotowski
- Department of Pediatric Otolaryngology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Cezary Witczak
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
- Correspondence:
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Hong E, Posligua A, Elwood H, Smidt AC. Excimer laser treatment for morphea-lichen sclerosus et atrophicus overlap in a pediatric patient. JAAD Case Rep 2022; 32:96-98. [PMID: 36698372 PMCID: PMC9867949 DOI: 10.1016/j.jdcr.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Emily Hong
- University of New Mexico, School of Medicine, Albuquerque, New Mexico
| | - Alba Posligua
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Hillary Elwood
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico,Pathology Associates of Albuquerque, Albuquerque, New Mexico,Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Aimee C. Smidt
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico,Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque New Mexico,Correspondence to: Aimee C. Smidt, MD, Chair, Professor of Dermatology and Pediatrics, Founding Director, Department of Dermatology, Vascular Anomalies Clinic, University of New Mexico School of Medicine, 1021 Medical Arts Ave NE, Albuquerque, NM 87102.
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