Diagnosis: Morphea
The 16-year-old girl with facial palsy, complete ptosis, and marked atrophy of subcutaneous and bony structures on the left upper side of the face before surgical intervention. Note the slight cleft a. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 2.0). Attribution: Gambichler et al..
Plaque morphea (most common): oval, indurated plaques with ivory-colored center and violaceous border ('lilac ring' indicates active inflammation). Linear morphea: band-like sclerosis, may cross joints causing contractures. En coup de sabre: linear forehead involvement.
More common in females, peak onset 20-50 years. No Raynaud or systemic sclerosis features. Linear morphea in children may affect underlying muscle and bone growth. Autoantibodies usually negative or low-titer ANA.
Superficial plaque: topical corticosteroids, calcipotriene, tacrolimus, UVA1 phototherapy. Deep/linear/generalized: methotrexate + systemic corticosteroids (first-line). Mycophenolate for refractory. Physical therapy for linear morphea crossing joints.
Systemic sclerosis, Lichen sclerosus, Lipodermatosclerosis, Radiation-induced fibrosis, Eosinophilic fasciitis
The 'lilac ring' indicates active, treatable disease — treatment should target this stage. Linear morphea in children can cause significant morbidity (limb length discrepancy, facial hemiatrophy). Morphea does NOT progress to systemic sclerosis.
Tags: morphea, localized scleroderma, sclerotic, autoimmune, fibrosis