Fitzpatrick's Dermatology 8ed

1. 醫六CLERK吳易儒 ⿈黃伊妊
TOPIC
DATE REPORT
2014.03.06
CHAPTER 64: MORPHEA
FITZPATRICK’S DERMATOLOGY 8ED

2. Outline of morphea
Occurs in children and adults
Children: Linear subtype
Adults: Circumscribed and generalized subtypes
A self-limited or chronically relapsing autoimmune disorder
Inflammatory, sclerotic, atrophic
Thickened sclerotic skin
Systemic disease: arthritis, neurological disorders
Differentiated from scleroderma(localized)

5. Epidemiology
2.7 per 100,000
female:male=2:3.1
20-30% begin in childhood(can occur any age)
25-80% of pediatric subtype are linear
70-80% limb/trunk
22-30% ECDS(en coup de sabre)/PHA(Progressive
facial hemiatrophy)
3-6 years, 20% reactivation

6. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
Chronicity and sequelae
left leg, 5y/o
abdomen, 16 y/o
right shoulder, 19 y/o
muscle atrophy, limb length discrepancy, pes plans foot deformity
From: Chapter 64. Morphea
Fitzpatrick's Dermatology in General Medicine, 8e, 2012
!

7. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
After breast reconstruction and irradiation
Not Metastatic carcinoma
Morphea lesion
Legend:
From: Chapter 64. Morphea
Fitzpatrick's Dermatology in General Medicine, 8e, 2012
!

8. Clinical Findings

11. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
Lichen Sclerosis overlie on Morphea lesions
:
From: Chapter 64. Morphea
Fitzpatrick's Dermatology in General Medicine, 8e, 2012
!

12. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
A. Typical active morphea plaque in inflammatory stage, with violaceous border.
B. In patient with linear morphea-> Severe atrophy (atrophic stage)
Cutaneous Lesions

13. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
A. Isomorphic plaques : bra and waistband areas.
B. Symmetric plaques
Generalized morphea

14. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
majority of body surface area (A),
sparing the fingertips (B).
Pansclerotic morphea

15. A. Multiple linear lesions involving trunk and extremities.
B. B. En coup de sabre.
C. Multiple hyperpigmented linear morphea lesions on the face.
Linear Morphea

16. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
(involves deep dermis, subcutaneous, fascia, muscle)
Morphea profunda: involved areas have “cobblestone” appearance with subcutaneous atrophy.
Deep Morphea(Morphea profunda)

17. Date of download: 3/4/2014 Copyright © 2012 McGraw-Hill Medical. All rights reserved.
Arthritis: swollen right knee with effusion in patient with morphea.
Related Physical Findings

18. squared-off edge of the biopsy specimen with
mild superficial and deep inflammatory infiltrate and
broadened compact collagen fibers, generally parallel to the epidermis.
Histopathology

19. Q & A
What may elevate when we check Morphea
patients' specimen?!
!
(A) ANA!
(B) IFN-α!
(C) IL-10!
(D) None of above

20. Answer
Ans:(A)!
Morphea is related to familial autoimmune disorders.!
!
Autoantibodies reported include:!
ANA(39-80%), antisincle-stranded DNA, antidouble-
stranded DNA, antihistone, antitopoisomerase IIα,
antiphospholipid, anticentromere, anti-Scl-70!
!
And reumatic factor:!
MMP-1

21. THANKS