Morphea

Diagnosis: Morphea

Clinical History

Indurated, sclerotic plaques with characteristic violaceous border (active phase) progressing to ivory-white center. Distribution, depth of involvement, functional impairment.

Treatment

Superficial/limited: potent topical corticosteroids, calcipotriol, tacrolimus, UVA1 phototherapy. Deep/linear: systemic methotrexate ± systemic corticosteroids. Physical therapy for joint involvement.

Differential Diagnosis

• Systemic sclerosis (scleroderma) • Lichen sclerosus • Radiation dermatitis • Nephrogenic systemic fibrosis • Eosinophilic fasciitis • Vitiligo (early morphea) • Lipodermatosclerosis

Key Learnings

• Localized scleroderma — fibrosis confined to skin ± subcutaneous tissue • Does NOT typically progress to systemic sclerosis (different disease) • "Lilac ring" sign: violaceous border indicates active, inflammatory phase • En coup de sabre: linear morphea of the forehead — Parry-Romberg syndrome overlap • Histology: thickened, homogenized collagen bundles replacing subcutaneous fat • Active disease: positive anti-ssDNA, elevated eosinophils, elevated ESR • Linear morphea in children can affect bone growth if crossing joints

Tags: dermatologist, dermatology, kodachrome, Morphea