clobetasol and Scleroderma--Localized

DEFINITION AND FREQUENCY: Localized scleroderma, also known as morphea, is a sclerotic condition limited to the skin. The specific clinical entity depends on the extent, linear disposition and depth of the lesions. Morphea is ten times more prevalent than systemic sclerosis, and its prognosis is generally good: superficial forms resolve within 3 years.. In the absence of symptoms, examinations to detect systemic involvement are purposeless. Plaque morphea is the most frequent clinical presentation. Serious manifestations include extensive morphea that may involve the entire skin or linear forms, especially in children, where they may be severe, especially on the face. There are no immunological markers clearly associated with morphea and no causative agents have been implicated in its pathogenesis, although sclerodermiform dermatitis is reported to be associated with some drugs and toxic agents.. There is no consensual treatment for morphea. Treatment should be decided according to severity and extent of lesions. Limited lesions may be treated with local steroids such as class IV corticosteroids. Systemic treatment (methotrexate) should be discussed in extensive and linear forms when there is a risk of functional or esthetic complications.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Age Factors; Anti-Inflammatory Agents; Balneology; Child; Clinical Trials as Topic; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Incidence; Male; Methotrexate; Prevalence; Prognosis; PUVA Therapy; Risk Factors; Scleroderma, Localized; Sex Factors; Tacrolimus; Time Factors; Treatment Outcome

Dear Editor, cutaneous chronic graft versus host disease (cGVHD) is a pathological process consisting of donor-derived T-cells aimed at the antigens of the recipient. It exhibits a large range of clinical presentations resembling morphea and deep sclerosis/fasciitis, all characterized by both inflammation and progressive dermal and hypodermic fibrosis (1). Although classic scleroderma-like lesions in cGVHD are nummular or irregular plaques and linear bundles associated with hypo- or hyperpigmentation (2), we report an atypical case with ulcerative presentation. No other case-reports of morphea-like or scleroderma-like cGVHD with an ulcerated appearance after liver transplantation (LT) and magnetic resonance imaging (MRI) correlation have been found in the literature. CASE REPORT Ten months after LT due to an end-stage cirrhosis associated with multifocal hepatocarcinoma (HCC), a 61-year-old man on immunosuppressive therapy with Tacrolimus (1 mg) and Everolimus (10 mg) presented to our clinic for a skin lesion in the right scapular region. We observed a flat ulcerated plaque with areas of sclerosis, minimal necrosis, and well-defined slightly erythematous margins (Figure 1, a). On palpation, the plaque had a hard consistency and was slightly painful. The skin lesion had been preceded by subjective discomfort with stinging sensation for seven months before its onset. Gradually lesion developed starting from a small, flat, oval purplish plaque associated with a progressive increase in pain. Patient denied dysphagia, retrosternal heartburn, Raynaud's phenomenon, arthralgia, and dyspnea. A previous MRI (Figure 2, a,b) showed subcutaneous and muscle edema. Blood tests showed abnormal liver function indexes due to extrahepatic cholestasis, while C-reactive protein, erythrocyte sedimentation rate, and leukocytes were within normal ranges. Self-reactive antibodies were negative. Histological examination (Figure 1, b) identified rare dyskeratotic keratinocytes and basal lymphocyte infiltrate, a dermal dense fibrosis with the disappearance of the skin appendages, and large fibrous septa in the adipose panniculus. It led to the diagnosis of scleroderma/morphea, based on the patient's clinical history. The diagnosis of graft versus host disease scleroderma-like post liver transplant was established. The lesion was treated by topical application of 0.05% clobetasol once a day. We did not use systemic immunosuppressive therapy in order to prevent HCC recurrence. The pat

Topics: C-Reactive Protein; Clobetasol; Everolimus; Fibrosis; Graft vs Host Disease; Humans; Inflammation; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Scleroderma, Localized; Sclerosis; Skin Diseases; Tacrolimus; Ulcer

Morphoea, or localised scleroderma, is a disease entity with poorly understood pathogenesis. Early diagnosis of the condition is crucial in order to prevent permanent morbidity. However, initial presentations of morphoea can be nonspecific and easily mistaken for other conditions, resulting in late treatment and permanent disability. We report a case of linear morphoea in a 22-year-old man who was initially diagnosed with reflex sympathetic dystrophy. By the time the diagnosis of morphoea was confirmed, the patient had already developed contractures.

Topics: Clobetasol; Collagen; Diagnosis, Differential; Disease Progression; Fibrosis; Humans; Male; Phototherapy; Reflex Sympathetic Dystrophy; Scleroderma, Localized; Young Adult

A 43-year-old woman presented with a widespread morphea, which had its onset three months before. The patient had several plaques of active, pigmented, lilac halo disease on the trunk, arms and thighs. A biopsy confirmed that the patient was suffering from morphea. Therapy with clobetasol propionate ointment 0.05% was introduced, applied twice a day, 5 days a week. After a month, the ointment failed to significantly improve the lesions. Then the patient was treated with clobetasol ointment in the morning and tacalcitol ointment 4 mcg/g in the evening. This combination resulted in marked improvement of the disease after 20 days of therapy, and we decided to stop topical steroid. After three months of treatment with topical tacalcitol once a day, the plaques regressed considerably and only a very slight pigmentation remained. Therapy was further reduced to one evening, every other day for six months more, and then was suspended completely. No side effects were observed and there was no recurrence at 24-month follow up.

Topics: Adult; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Dihydroxycholecalciferols; Humans; Scleroderma, Localized

We describe a 54-year-old woman who developed right breast morphea after radiotherapy following a lumpectomy for infiltrating lobular carcinoma. Skin biopsy confirmed the histological features of morphea. Treatment was initiated with both topical and intralesional steroid, resulting in marked improvement. Morphea following radiotherapy is an infrequently recognized phenomenon. However, when diagnosed early it may be effectively managed with local steroid treatment.

Topics: Administration, Topical; Anti-Inflammatory Agents; Breast Neoplasms; Carcinoma, Lobular; Clobetasol; Combined Modality Therapy; Female; Glucocorticoids; Humans; Middle Aged; Radiation Injuries; Scleroderma, Localized