Morphea — Clinical Case (Wikimedia Commons)

Diagnosis: Morphea

Symptoms Signs and symptoms of morphea vary, depending on the type and stage of the condition. They include: Reddish or purplish oval patches of skin, often on the abdomen, chest or back Patches that . Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: Masryyy.

Clinical Presentation

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.

Clinical History

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.

Treatment

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.

Differential Diagnosis

Systemic sclerosis, Lichen sclerosus, Lipodermatosclerosis, Radiation-induced fibrosis, Eosinophilic fasciitis

Key Learnings

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