A Rare Case of Bullous Morphea Associated with Autoimmune Hepatitis.

(1) Background: Bullous morphea is an extremely rare form of localized scleroderma, a condition that is marked by the presence of sporadic and intermittent blisters on sclerodermatous skin. This condition stands out due to its rarity and the unique manifestation of blistering, which sets it apart from other forms of localized scleroderma. Due to the infrequent presentation of bullous morphea, there is a significant gap in our understanding of its pathogenesis. The exact mechanisms that lead to the development of this condition remain largely unknown, which poses a challenge for medical professionals in terms of both diagnosis and treatment. The limited number of reported cases makes it difficult to establish a standardized approach to managing this condition, and as a result, treatment options are often limited and may vary from one patient to another. (2) Methods: In this case report, we present a rare case of bullous morphea that manifested before the onset of autoimmune hepatitis. When morphea presents unusually or is resistant to traditional immunosuppressive treatment, a comprehensive assessment of possible concurrent autoimmune illnesses provoking the rash must be conducted. (3) Results: We report a successful case of bullous morphea treated with systemic corticosteroids following a diagnosis of autoimmune hepatitis. (4) Conclusions: This case highlights the importance of considering overlapping autoimmune conditions in the management of bullous morphea and the potential efficacy of systemic corticosteroids in such scenarios. Collaborative efforts involving dermatologists, rheumatologists, and hepatologists are essential to enhance understanding and optimize treatment outcomes for patients affected by this rare and complex condition. Thus, further research is necessary to gain a deeper understanding of the pathogenesis of bullous morphea and to develop more effective and targeted treatment options for patients affected by this condition.

A case of radiation-induced bullous morphea/lichen sclerosus overlap in a breast cancer patient.

Radiation induced morphea (RIM) is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical treatment options. In many cases, the radiation oncologist is the first person to learn of the initial skin changes, often months before a dermatologist sees them. In this paper we present a breast cancer patient who developed a rare bullous variant of RIM, which delayed her diagnosis and subsequent treatment. It is imperative to diagnose RIM early as it carries significant morbidity and permanent deformity if left untreated. The lesions typically present within 1 year of radiation therapy and extend beyond the radiated field. RIM is often mistaken for radiation dermatitis or cellulitis. Bullae, when present, are often hemorrhagic in appearance, which can serve as another clinical clue. It is important to refer these patients for a full gynecologic exam as there can be concurrent anogenital lichen sclerosus et atrophicus which is both debilitating and carries a long term risk for squamous cell carcinoma. Treatment with systemic agents is often necessary, and can be managed by a dermatologist. The most proven regimen in the literature appears to be methotrexate, with our without concurrent narrow band UVB phototherapy.

[Generalized circumscribed scleroderma with blisters]. / Generalisierte zirkumskripte Sklerodermie mit Blasenbildung.

The patient suffered from a 20-year course of generalized circumscribed scleroderma and presented with blisters in circumscribed areas of the affected skin. The development of subepidermal blisters has been described in all clinical forms of circumscribed scleroderma. Aetiology and pathogenesis of blister formation have not yet been clarified. An obstruction of the lymphatic vessels due to the present sclerosis is favoured. Treatment of bullous circumscribed scleroderma is considered to be difficult. Oral steroids, methotrexate, hydroxychloroquine and PUVA methods have been used with varying success.

Morfea ampollosa. tratamiento exitoso con fototerapia uva-1, calcipotriol y superóxido dismutasa: reporte de un caso / Bullous morphea / Morfe de bullo

La morfea ampollosa es un tipo infrecuente de morfea, por esta razón existe poca evidencia en la literatura acerca del mejor tratamiento para esta patología. Presentamos el caso de una niña de 10 años a quien se le realizó un diagnóstico de morfea ampollosa, y fue tratada exitosamente con fototerapia UVA-1, calcipotriol y superóxido dismutasa.

Bullous morphea is an infrequent type of morphea, for this reason there is not much evidence on the literature about the best treatment for this condition. We introduce the case of a 10 years old child with a bullous morphea diagnosis; she was successfully treated with phototherapy, calcipotriene and superoxide dismutase.

Morfea bolhosa é um tipo de morphea infreqüente, por isso não há muita evidência na literatura sobre o melhor tratamento para esta condição. Apresentamos o caso de uma criança de 10 anos com diagnóstico de morféia bolhosa; Ela foi tratada com sucesso com fototerapia, calcipotriol e superóxido-dismutase.

Three cases of bullous morphea: histopathologic findings with implications regarding pathogenesis.

Bullous morphea is a rare variant and is not frequently reported. We present three cases of bullous morphea. Although lymphangiectases have been suggested as the most likely mechanism for the development of the bullae in cases of morphea, none of the cases presented with lymphangiectases. To the contrary, all of our cases showed hemorrhagic content in the bullae, which suggests local trauma as a mechanism involved in bulla formation.