Linear Morphea in the Context of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Unique Dermatological Manifestation.

Morphea, a rare skin disorder characterized by localized areas of thickened and sclerotic skin, typically presents as circumscribed plaques. The linear variant, however, manifests as linear bands of sclerosis affecting the extremities, and its association with coronavirus disease 2019 (COVID-19) has not been documented until now. In this article, we present the case of a 22-year-old previously healthy female patient who contracted COVID-19 complicated by an erythroedema on the back of the right hand, extending notably to the forearm on the 10th day of the infection. Skin biopsy revealed dermal and septal hypodermal fibrosis with a mild lymphocytic interstitial infiltrate in the dermis consistent with morphea. Treatment with low-dose corticosteroids was started, and regular follow-up was established. An isolated recurrence of cutaneous symptoms was observed after the first COVID-19 vaccination (Sputnik V) administered five months after the initial infection, with spontaneous regression in 10 days. This clinical evolution underscores the importance of a comprehensive understanding of dermatological manifestations in COVID-19, particularly in the context of post-infection vaccination.

Generalized morphea following COVID-19 vaccine: Case report and literature review.

Physicians should be vigilant for COVID-19 vaccine side effects and investigate any associated cutaneous manifestations. This will ultimately facilitate better understanding and recognition of various skin reactions related to the vaccine.

Bullous lichen sclerosus-generalized morphea overlap syndrome improved by tofacitinib.

We here report a case of a middle-aged man with an unusual case of bullous lichen sclerosus complicated with generalized morphea. He showed initial recurrent flaccid bullae, followed by ivory-white sclerotic plaques and extensive skin sclerosis, with additional walking disorder caused by knee-joint contracture, and ulcers on the lower extremities and back. The patient had no visceral involvement. After oral hydroxychloroquine and oral corticosteroids failed, the patient was given tofacitinib, which resolved his ulcers after 4 weeks and ameliorated his knee-joint contracture and skin sclerosis within 4 months. Owing to the occurrence of diffuse large B-cell lymphoma, he stopped using tofacitinib, and the ulcer and walking disorder reappeared. This is rare case of bullous lichen sclerosus-generalized morphea overlap syndrome. The patient recovered well after treatment with tofacitinib. His symptoms recurred after discontinuation of tofacitinib.

Generalized Morphea Coincident With Aplastic Anemia: A Case Report.

Morphea is a rare skin condition characterized by erythematous or violaceous lesions as well as sclerotic plaques. Patients with morphea frequently have other autoimmune disorders. Contributing factors are thought to be autoimmunity and an increase in extracellular matrix production. A case of a 45-year-old male patient with progressive restriction of both shoulder movements and patchy discoloration over the abdomen, neck, back, forearms, and bilateral axillae is discussed in this article. Examination revealed multiple shiny hyperpigmented to hypopigmented indurated plaques, and some lesions showed erythematous to violaceous borders, fine scales, and woody induration. The neurological examination was normal. Skin biopsy showed a sparse superficial perivascular lymphohistiocytic infiltrate with thickening of collagen bundles that were hyalinized in the reticular dermis, which was consistent with superficial morphea. Hematological tests showed pancytopenia and bone marrow aspiration revealed hypocellular marrow, which was consistent with aplastic anemia. The patient was diagnosed with generalized morphea with aplastic anemia. The patient was referred to a transplant center for further treatment, but, unfortunately, he died of sepsis while waiting for his transplant. Our case may indicate a possible link between aplastic anemia and generalized morphea. Due to a possible similar underlying mechanism of pathogenesis, treatment of aplastic anemia may be effective in morphea also. Aplastic anemia must be detected early to reduce complications and mortality in patients.

Pansclerotic Morphea Following COVID-19: A Case Report and Review of Literature on Rheumatologic and Non-rheumatologic Dermatologic Immune-Mediated Disorders Induced by SARS-CoV-2.

While mucocutaneous manifestations of COVID-19 have been frequently reported and added to our knowledge every day during the pandemic, another issue is the COVID-related diseases that can present as intensified lesions of underlying diseases, a new disease, or changes in the behavior of an old lesion. Given that immune system overreaction and cytokine storm are among the most prominent events in COVID-19, the incidence of autoimmune diseases is expected to increase after COVID-19, as confirmed in several reports. To increase the body of knowledge about short- and long-term outcomes of COVID-19 for specialists, it is essential that similar cases be reported and collected for years to come. The present study investigated a case of pansclerotic morphea that rapidly progressed a few weeks after infection with COVID-19 in a 57-year-old woman with no history of any autoimmune skin or rheumatic diseases. She was prescribed outpatient COVID-19 treatment of azithromycin, vitamins D and C, and then quarantined for 2 weeks. The manifestations of the disease were exacerbated at each follow-up and sampling visit at short intervals. This kind of pansclerotic morphea is reported for the first time.

Eosinophilic fasciitis associated with generalized morphea and IgA nephropathy.

Eosinophilic fasciitis (EF) is a rare connective tissue disease characterized by increased peripheral blood eosinophils and diffuse fasciitis, generalized morphea (GM) is a subtype of localized scleroderma, and IgA nephropathy is a chronic glomerulonephritis caused by abnormal deposition of IgA in the mesangial area of the glomeruli. We describe a 49-year-old male patient with hard skin, cutaneous hyperpigmentation, and proteinuria. The patient had suffered from a long disease course of hard skin, while urine protein was newly detected. Finally, the clinical presentation and physical examination, limb MRI, skin biopsy, and renal biopsy confirmed the diagnosis of eosinophilic fasciitis associated with generalized morphea and IgA nephropathy. This case is the first report of EF associated with GM and IgA nephropathy.

Cutaneous Chronic Graft Versus Host Disease in a Symmetric Distribution.

Graft-versus-host disease (GVHD) is a common complication following patients who have undergone allogenic hematopoietic stem cell transplantation (allo-HSCT). While GVHD has been previously sub-categorized through a temporal relationship upon transplantation, revisions from the National Institutes of Health have modified the diagnosis criteria to be more involved with specific signs and symptoms. Chronic classifications of GVHD include non-sclerotic and sclerotic forms, and the sclerotic form can be further classified based on morphologies such as lichen-sclerosis-like, sclerodermoid or morphea-like plaques. Generalized morphea can have similar histopathological findings but in order to be diagnosed, certain diagnostic criteria must be met. Herein, we report a patient with linear and inflammatory morphea morphology of chronic GVHD, which presents symmetrically on both lower extremities.

Anti-Centromere Antibody Positivity in a Patient with Generalized Morphea.

We report the case of a 45-year-old female with generalized morphea (GM), who exhibited positivity for the anti-centromere antibody (Ab). She frequently developed multiple sclerotic skin lesions, whose histological findings were compatible with morphea. She demonstrated favorable responses to topical and oral steroids. Cases of GM associated with systemic sclerosis (SSc)-specific Abs (anti-Scl-70 Ab, anti-centromere Ab, and anti-RNA polymerase III Ab) have rarely been reported. The previously reported GM cases involving anti-SSc-specific Abs exhibited some skin manifestations of SSc, such as nailfold capillary changes. However, our case did not show any signs of SSc or limited cutaneous SSc. More cases are needed to clarify whether GM with SSc-specific Abs leads to SSc.

Generalized morphea/eosinophilic fasciitis overlap after epoxy exposure.

Generalized morphea is associated with epoxy resin vapors and is characterized by the development of lesions shortly after exposure. Morphea presenting along with eosinophilic fasciitis (EF), or morphea/EF overlap, is rare and an indicator of poor prognosis and resistance to treatment. Here we present a case of generalized morphea/EF overlap linked to epoxy exposure. Our patient received multiple therapies-ultraviolet A1 phototherapy, prednisone, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, and rituximab-none of which led to a significant response. The refractory nature of this disease warrants vigilance in its association with epoxy exposure.

Methotrexate: an effective monotherapy for refractory generalized morphea.

INTRODUCTION: Morphea is an inflammatory skin disorder characterized by excessive collagen deposition. Although treatment algorithms for morphea subtypes have been suggested, no consistent recommendations are available. This study attempts to evaluate the clinical efficacy of methotrexate (MTX) as monotherapy in refractory generalized morphea. METHODS: It is a retrospective study, including 20 patients who had already been treated with various topical and systemic therapies with minimal clinical improvement. Patients received orally MTX at a of dosage 15 mg once weekly. Duration of the use, dosage of MTX, and adverse events were recorded. Clinical assessment of skin lesions was performed and documented. RESULTS: The mean disease duration was 27 months before the initiation of MTX treatment. After 12 months of therapy, very good response was achieved in 6 patients (30%), good response in 10 patients (50%), and fair response in 2 patients (10%), while 2 patients (10%) had failed treatment. Patients were followed up for a mean time interval of 21 months. No serious adverse event was recorded. CONCLUSION: MTX has been already proved to be an effective and well-tolerated treatment in pediatric patients with morphea. The majority of the group of adult patients showed very good and good improvement when treated with MTX. Although this is an uncontrolled study, MTX monotherapy was considered a safe and effective treatment for the management of this specific clinical subset of morphea in adults.

Successful infliximab therapy in a patient with comorbid spondyloarthritis, primary biliary cirrhosis and generalized morphea.

The patient in this report was diagnosed simultaneously with primary biliary cirrhosis (PBC), spondyloarthritis, and generalized morphea and was started on infliximab therapy. In addition to an improvement in clinical symptoms with this therapy, an improvement was also observed in laboratory parameters such as cholestatic enzymes, C-reactive protein, and erythrocyte sedimentation rate. Infliximab was well tolerated in this 56-year-old patient. However, further studies must be performed in order to clarify the therapeutic role of TNF-α blockers in, PBC and generalized morphea.

Generalized morphea with concurrent vitiligo in a four-year-old boy

Morphea, a localized type of scleroderma, is a rare fibrosing disorder of the skin that presents with a variety of clinical manifestations such as linear morphea, plaque morphea, generalized morphea and other miscellaneous groups. It has an incidence rate of 0.4-2.7 cases per 100,000 people. Generalized morphea is defined as four or more plaques larger than 3cm, and/or involving of two or more anatomical sites. Among pediatric population, 5% of the cases present as generalized morphea. Concomitant vitiligo is found in in 7% of morphea cases. We report a case of generalized morphea in a four-year-old boy who presented with a one-year history of multiple, well-defined, indurated, annular, skin-colored to hyperpigmented plaques with central atrophy on the mid to lower back and left cheek. There was also concurrent two-year history of multiple ill-defined vitiliginous patches on the upper back, upper arms, and elbow.