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Localized morphoea is a disease characterized by localized sclerosis of the skin. The disease has been associated with several skin diseases. The case documented here is the first of its kind in which localized plaque type morphoea was seen in a patient with long standing oral submucous fibrosis.
A subcorneal pustular dermatosis and a vesicobullous eruption with the clinical ad histologic features of localized bullous pemphigoid(BP) were observed in a 44-year-old woman with morphea and a recent history of phenytoin sodium-induced toxic epidermal necrolysis. Localized BP is rare and has been previously described in association with other cutaneous disorders. The coexistence of localized BP, morphea, and subcorneal pustulosis suggests that immunologic factors may play a role in all three conditions.
We describe a case of morphea which presented further typical lesions of the disease at the sites of mechanical trauma. It can be suggested that cutaneous lesions of morphea may be locally developed due to physical stimuli as an isomorphic response in patients or subclinical cases of the disease.
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We present details of nine patients who developed morphoea after radiotherapy. In every patient morphoea began within the irradiated area and in four spread beyond it. We believe the irradiation triggered the morphoea despite the absence of any clear-cut relationship to dosage or severity of the acute reaction. Dermatologists and radiation oncologists should be aware that this condition may lead to the mistaken diagnosis of a local tumour recurrence.
Six patients with well-circumscribed, indurated, inflammatory plaques of the lower extremity are described. Incisional biopsy specimens in each patient revealed fat necrosis, sclerosis, and a lobular panniculitis. These patients are similar to those described under the designations hypodermitis sclerodermaformis or lipodermatosclerosis. The name sclerosing panniculitis is proposed to unify these conditions. The pathogenesis is unknown, although a role for venous stasis or previous thrombophlebitis has been proposed. Systemic or local anti-inflammatory therapies have not been clinically effective.
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.
Scleroderma is a fibrotic disease occurring in a localized or systemic form. The pathogenesis of scleroderma remains poorly understood. Recent studies revealed that various cytokines and growth factors were involved in the development of scleroderma fibrosis. Platelet-derived growth factor (PDGF) is a potent growth factor for mesenchymal cells, especially fibroblasts. It can promote fibroblasts proliferation, enhance extracellular matrix synthesis. It is also a chemoattractant to fibroblasts. To better understand the role of PDGF in pathogenesis of scleroderma, we performed both in vivo studies on the expression of PDGF beta-receptor protein in scleroderma tissue and in vitro studies on the expression of PDGF B-chain and PDGF beta-receptor mRNA in cultured fibroblasts derived from both lesions of scleroderma and normal skin. Immunohistochemistry staining showed that PDGF beta-receptor expression was greatly elevated in the dermis of scleroderma lesion whereas PDGF beta-receptor were expressed at low levels in normal skin. Northern blot analysis showed that cultured fibroblasts from scleroderma had higher expression of PDGF B-chain and PDGF beta-receptor mRNA than those from normal control. Two PDGF B-chain mRNA transcripts, 2.8 and 4.0 kb, were expressed. The 2.8 kb transcripts which had more efficient translation ability was the more predominantly expressed one. These results indicate that PDGF B-chain/PDGF beta-receptor signal pathway might be involved in the development of fibrosis in scleroderma, and that the 2.8 kb PDGF B-chain mRNA transcript may be the main modulation gene.
Two patients showed symmetrical sclerodermoid (morphea-like) skin lesions at sites of intramuscular phytonadione (vitamin K1) injections. The lesions appeared one and two years after the injections. A dense sclerosis involving the reticular dermis and subcutaneous fat was observed on histologic examination of biopsy specimens. Local adverse reactions to phytonadione are reviewed. Possible causative mechanisms for phytonadione-induced pseudoscleroderma are discussed.
A family with childhood onset of hypotrichosis and morphea with apparent autosomal dominant inheritance is reported. Careful literature review suggests that this is a previously undescribed disorder.
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Granuloma annulare and localized morphoea are both well described in the dermatological literature. We now present two patients with both of these diseases, a comorbidity rarely described. A possible pathogenic relationship is discussed.
Localized morphoea uncommonly occurs in a linear distribution and may present following trauma, although most cases are idiopathic. Pigmented purpuric dermatoses such as lichen aureus may also rarely occur in a linear distribution and have been associated with trauma. A middle-aged man is described who initially presented with lesions typical of lichen aureus in a linear distribution at a site exposed to chronic low-grade trauma. This eruption was transient and clinically underwent spontaneous complete resolution. Several months later he developed localized morphoea in an identical distribution. To our knowledge this is the first reported case of a pigmented purpuric dermatosis, presumably precipitated by trauma, evolving into linear morphoea.
Connective tissue diseases are the most important organic causes of Raynaud's phenomenon, and systemic sclerosis is the most frequent one. Careful history taking and clinical examination eventually lead to further investigations where capillaroscopy and specific autoantibodies tests have the best performances to reach diagnosis. Our understanding of local regulation of blood flow has been improved discovery of new neuromediators and local substances derived from endothelium. These compounds have direct implications for medical therapy and represent new hopes for the treatment of Raynaud's phenomenon which, however, remains difficult and incomplete for most patients.
Low transcutaneous oxygen tension (Ptc,O2) values in the supramalleolar skin of patients with venous disease are often reported. This measurement involves heating the skin to 43 degrees C to cause maximum vasodilatation and is valid only if liposclerotic and normal skin can vasodilate to the same degree. Forty-four limbs were studied, 15 with lipodermatosclerosis (LDS), 14 with uncomplicated varicose veins, and 15 controls. A Ptc,O2 electrode was modified to incorporate a laser Doppler probe. Laser Doppler flux was measured in the supramalleolar skin before and after local heating to 43 degrees C and the relative increase in flux was measured. The Ptc,O2 was then measured at the same site and on the chest. Vasodilatory capacity was expressed as the ratio of peak:basal laser Doppler flow, and the Ptc,O2 was expressed as a leg:chest ratio. Median laser Doppler flow was higher in limbs with LDS (median 67 mV) than in normal limbs (median 40 mV) (P less than 0.03). Ptc,O2 was higher in control limbs (median ratio 0.94) than in limbs with LDS (median 0.53) (P less than 0.006). The microcirculation in LDS had less capacity to vasodilate after heating (median factor of increase 5.4) than normal skin (median factor of increase 12.3) (P less than 0.001). A simple regression analysis was performed on all pairs of data, and revealed a correlation between Ptc,O2 and vasodilatory capacity (r = 0.524, P less than 0.001). The results indicate that low Ptc,O2 levels in venous disease reflect an inability of the microcirculation to increase its flow in response to local heating; inferences about the oxygen content of liposclerotic skin at normal temperatures cannot be drawn using this technique.
BACKGROUND: A peculiar type of fat necrosis was noted in some patients with various skin diseases. OBJECTIVE: We attempted to develop a classification of membranous lipodystrophy combining the results of our study and a review of other articles. METHODS: Five cases of skin diseases with membranous lipodystrophy were studied and their clinical and histopathologic features were analyzed. Previous reports of similar findings were reviewed. RESULTS: Membranous lipodystrophic changes were noted in morphea profunda, lupus panniculitis, and factitial ulcer. Microcysts were formed by the coalescence of the destroyed fat cells and were lined by amorphous, eosinophilic material. Some of the linings had a crenelated appearance. Microgranules were found in the histiocytes and in the hyalinized collagen stroma. The linings and microgranules stained positively with periodic acid-Schiff, were resistant to diastase, and also stained with Sudan black B. CONCLUSION: We propose the use of the term secondary membranous lipodystrophy to describe the local subcutaneous membranous lipodystrophic change that occurs as a result of other skin diseases, in contrast to primary idiopathic membranous lipodystrophy, which occurs without any antecedent factors.
Autologous fat grafts have recently gained popularity in the treatment of soft tissue defects of the face. We report on two patients with circumscribed scalp alopecia and linear forehead depressions treated with a combination of scalp reduction and autologous fat implants. The patients had significant cosmetic improvement without complications.
The most important aim of compression therapy in postthrombotic legs is prevention of dermatosclerosis and ulcus cruris. For the acute stage of leg swelling and for venous ulceration we prefer compression bandages ("therapy phase"). The effect of compression therapy with bandages depend on the material of the used bandages (short or long-stretch bandages), the stretching the bandages are applied with, the number of layers, the local pads and on well done application of the bandages. After removal of oedema compression therapy should be continued with medical compression stockings ("maintenance phase"). Compression stockings should be fit on carefully and be checked from time to time to guarantee their application by the patient.