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Results for “Scleroderma, Localized”

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PubMed2002

Adult acral cutaneous myofibromas in a patient with generalized morphea.

Myofibroma is the term for a group of solitary or generalized soft tissue tumors that may be located in the skin or within skeletal muscle, bone, and viscera. These tumors occur most commonly in children. However, examples of myofibroma have been reported in adults, in whom they usually present as solitary lesions of the head and neck, trunk, and extremities. "Cutaneous nodules" have been reported in both localized and systemic scleroderma, but to our knowledge, there are no specific reports of myofibromas developing in this patient population. We report a case of acral myofibromas in a patient with generalized cutaneous morphea. This occurrence is of interest in view of the possible role of myofibroblasts in the pathogenesis of scleroderma.

Aged↗
PubMed1997

Eosinophilia-myalgia syndrome, eosinophilic fasciitis, and related fibrosing disorders.

Clinically distinct fibrosing processes affecting the skin, selected internal organs, or both in a characteristic pattern are a common cause of morbidity. In addition to systemic sclerosis, the prototype idiopathic fibrosing disorder, these conditions include the eosinophilia-myalgia syndrome, epidemic toxic oil syndrome, eosinophilic fasciitis, localized forms of scleroderma, keloid, and the newly described entity of fibrosing colonopathy. The pathogenesis of these disorders, although still incompletely understood, appears to share similarities with that of systemic sclerosis. Insights into these diseases have recently emerged from epidemiologic and toxicoepidemiologic investigations, in situ hybridization and polymerase chain reaction amplification of target genomes, and in vivo and in vitro experimental research. Minor contaminants in food supplements, activation and degranulation of eosinophils, altered expression of CD34 antigen on dendritic cells, disordered regulation of fibroblast apoptosis and proliferation, infection with Borrelia organisms, and cytokines such as transforming growth factor-beta, interleukin-4, and connective tissue growth factor are implicated in inducing an accentuated and persistent fibrogenic host response to injury, resulting in tissue fibrosis. In addition, humoral and cellular autoimmunity may also be implicated.

Colonic Diseases↗
PubMed1985

Localized eosinophilic fasciitis in a patient with rheumatoid arthritis.

A case of eosinophilic fasciitis localized to the left thenar eminence in a patient with active rheumatoid arthritis is described for the first time. The clinical and pathologic similarities to localized forms of scleroderma, and the features that help to distinguish these conditions are discussed.

Adult↗
PubMed2000

A case of linear scleroderma and myasthenia gravis.

We report a case of a 28-year-old woman with myasthenia gravis who developed linear scleroderma seven years later. Myasthenia gravis and scleroderma are rarely found in direct association with each other; there are only five such reported cases, all of which were systemic scleroderma patients. Although localized and systemic scleroderma are distinct entities, autoimmunity is believed to be involved in the pathogenesis of both. Myasthenia gravis and scleroderma may occur coincidentally, but an autoimmune predisposition seems to be the more likely underlying cause, as evidenced by an increased incidence of autoantibodies and autoimmune diseases.

Adult↗
PubMed2002

Scleroderma-like cutaneous syndromes.

Several distinct entities associated with dermal fibrosis can mimic scleroderma/systemic sclerosis. The list of scleroderma-like conditions or scleroderma variants includes eosinophilic fasciitis, localized forms of scleroderma, scleredema and scleromyxedema, keloids, and environmental exposure-associated conditions including eosinophilia-myalgia syndrome and pseudosclerodermas induced by various drugs. Although these conditions are relatively uncommon, their accurate recognition is essential to avoid misdiagnosis and inappropriate therapy. The pathogenesis of these scleroderma variants appears to share similarities with each other and with that of scleroderma. Better understanding of scleroderma-like disorders is emerging through epidemiologic investigations, and in vivo and in vitro experimental research. Activation of eosinophils and disordered regulation of fibroblast collagen synthesis, apoptosis, and proliferation are recurrent findings in these disorders. The etiologic role of infection with Borrelia species or other microorganisms remains controversial. Cytokines such as transforming growth factor-beta, interleukin-4, interleukin-13, and connective tissue growth factor contribute to fibrosis in these disorders by inducing an accentuated and persistent fibrogenic response to tissue injury. The role of genetic factors in susceptibility and clinical expression of scleroderma-like conditions remains to be systematically addressed. Because of the relative rarity of these conditions, few well-controlled clinical treatment trials have been performed. In addition, there is no consensus on optimal management. Much anecdotal information and small clinical series indicate that phototherapy may have a role in the treatment of scleroderma-like conditions.

Diagnosis, Differential↗
PubMed2002

Animal model of sclerotic skin. V: Increased expression of alpha-smooth muscle actin in fibroblastic cells in bleomycin-induced scleroderma.

Scleroderma is a connective tissue disorder with unknown etiology. Myofibroblasts appear during fibrotic processes such as scleroderma, hypertrophic scarring, and wound healing. We previously established a mouse model for scleroderma by local injections of bleomycin. To determine the phenotype of the fibroblasts in sclerotic skin after bleomycin treatment, we examined the expression of alpha-smooth muscle actin (alpha-SMA), a marker for myofibroblasts, in lesional skin as well as in fibrous lung in this model. Dermal sclerosis was induced by daily local injections of bleomycin (100 microg/ml) for 3 weeks in C3H mice. Immunohistochemical examination showed that alpha-SMA-reactive cells were detectable on fibroblastic cells in bleomycin-injected skin at 1 week. There was a significant increase in the immunoreactive fibroblastic cells for alpha-SMA in lesional skin in parallel with the induction of dermal sclerosis. After 3 weeks' treatment with bleomycin, the number of alpha-SMA-reactive fibroblasts showed an 11-fold increase compared with that in control PBS-treated mice. alpha-SMA-positive cells were also detected in lung parenchyma after bleomycin treatment. Following concomitant treatment with anti-transforming growth factor-beta (TGF-beta) antibody with bleomycin, the number of alpha-SMA-positive fibroblastic cells was significantly reduced up to 50%, along with the reduction of dermal sclerosis. To confirm the protein level of alpha-SMA, immunoblotting was carried out. Results showed an increase of alpha-SMA expression in lesional skin at 3 weeks of bleomycin treatment, which was reduced following anti-TGF-beta antibody treatment. These data suggest that fibroblastic cells are phenotypically altered into myofibroblasts during the fibrotic process in the experimental model of bleomycin-induced scleroderma, which was considered mediated, for the most part, by TGF-beta. Blockade of TGF-beta may be a therapeutic intervention for scleroderma.

Actins↗
PubMed1979

Hypodermitis sclerodermiformis and unusual acid-fast bacteria.

We described two patients with localized, chronic, painful, scleroderma-like lesions of the lower part of the leg associated with venous stasis. This type of lesion has been termed "hypodermitis sclerodermiformis," and we review the literature pertinent to this entity. In addition, skin biopsy material was studied for the presence of acid-fast microbes. In both cases, Fite-Faraco-stained tissue sections contained many acid-fast coccoid and giant microbial forms suggestive of transitional L forms. Culture of the lesion in both cases was positive for Staphylococcus epidermidis. Until the cause is fully clarified, the search for acid-fast bacteria appears warranted in formed of pseudoscleroderma such as hypodermitis sclerodermiformis.

Adult↗
PubMed1994

[Bilateral linear temporoparietal scleroderma en coup de sabre].

Bilateral linear frontoparietal scleroderma en coup de sabre is an extremely rare form of localized linear scleroderma. In this paper the case of a 35-year-old woman with bilateral linear temporoparietal scleroderma en coup de sabre is presented. The manifestations that can be associated with linear scleroderma and the serologic abnormalities it involves are briefly discussed.

Adult↗
PubMed2006

[High-resolution ultrasonography: utility in diagnosis, treatment, and monitoring dermatologic diseases].

Although less precise than histological examination, high-resolution skin imaging is a noninvasive technique that provides complementary information to the clinical examination: the lesion's US structure as well as its lateral and depth extension. Ultrasonography helps in diagnosis and initial management by measuring melanoma thickness (so as to remove this lesion with safety margins) before destructive treatment (cryosurgery or radiotherapy), by showing tumor limits, or by detecting subclinical recurrence during the follow-up. In this paper, ultrasound images will be correlated with clinical and histological data in various clinical situations such as tumors, edema, cutaneous infiltration, sclerous tissues, hyperlaxity, and cutaneous aging.

Adolescent↗
PubMed2003

Expression of transforming growth factor-beta and platelet-derived growth factor in linear scleroderma.

Linear scleroderma (LS) is a localized form of scleroderma characterized by mononuclear cell infiltration and fibroblast proliferation. In the later stages of the disease, excessive collagen is deposited with concomitant skin and appendage atrophy. These symptoms suggest a breakdown of fibroblast cell function, and consequently, growth factors have been thought to play a role in the pathogenesis of LS. The present study examined the expression of TGF-beta and PDGF in skin biopsies obtained from patients with LS and from normal subjects. Samples were prepared for immunohistochemistry. To identify TGF-beta, two polyclonal antibodies were used: TGF-beta1 (RaB4) and TGF-beta2 (CL-B1/29) and, to identify PDGF, two monoclonal antibodies were used: PDGF-AA (3E-205) and PDGF-BB (1F-133). Staining for TGF-beta1 and TGF-beta2 was observed around blood vessels (endothelial cells), and sweat glands in both LS and normal skin. Staining for PDGF-AA and PDGF-BB was intense in endothelial cells and sweat glands in LS and normal skin. Mononuclear cell infiltrates and abnormal collagen bundles did not stain for TGF-beta or PDGF. The strength and extent of staining was evaluated in tissues using a scale from zero (no staining) to four (strong staining). The amount of TGF-beta1, TGF-beta2, PDGF-AA and PDGF-BB was found similar in LS and normal skin. These results do not support the hypothesis that the excessive fibroblast cell activity and abnormal collagen deposition observed in LS are associated with downregulation of TGF-beta or PDGF.

Adolescent↗
PubMed1990

[Scleroderma].

Sclerodermas may occur in two basic forms: localized sleroderma (LSc) and systemic scleroderma (SSc). Pseudoscleroderma as well as overlap syndromes have to be differentiated from these two variants. From the clinical point of view, localized scleroderma can be subdivided into type I = plaque-like LSc (= morphea), type II = linear LSc, and type III = deep LSc. According to the degree of the cutaneous involvement, systemic scleroderma can likewise be classified into type I = sclerodactylia, type II = acrosclerosis, and type III = scleroderma with primary involvement of the trunk (diffuse scleroderma). In LSc, we never find systemic involvement; SSc, in contrast, is almost always associated with Raynaud's phenomenon, changes of the esophagus, as well as an increased titer of antinuclear antibodies (Hep-2 cell test). Only 23% of our patients with LSc showed elevated ANA titers. We present and discuss data of 56 patients with LSc and 52 patients with SSc. Evidence in the literature as well as our own findings suggest that the pathogenesis of LSc is different from that of SSc. The influence of various mediators and cytokines on the collagen metabolism might be regarded as a theoretical approach in order to develop new therapeutic regimens. This is even more important since there is still no efficient mode of treatment for neither localized nor systemic scleroderma.

Antibodies, Antinuclear↗