Solitary Morphea Profunda Following Trauma Sustained in an Automobile Accident
Solitary morphea profunda (SMP) is a variant of localized scleroderma (LS). We report the case of a 50-year-old white woman with a history of trauma sustained in an automobile accident who presented with SMP on the right upper arm. We also provide a review of the classification, epidemiology, etiology, diagnostic studies, pathogenesis, physical findings, histopathology, treatment, and prognosis of SMP, along with other important details pertaining to the disease. We also provide a brief overview of LS and morphea profunda (MP).
Practice Points
- Localized trauma to the skin may be an inciting event to trigger morphea.
- Morphea is a clinical diagnosis but should be confirmed through biopsy to differentiate it from other similar entities.
Prognosis
Morphea has transitioned into systemic scleroderma in a small number of reported cases.10,16,20,36 Therefore, patient follow-up is imperative to consistently identify systemic evolution. Although visceral complications are rare in the setting of LS, associated clinical findings have been reported, including arthralgia, arthritis, contractures, and carpal tunnel syndrome, as well as pulmonary, esophageal, and cardiac abnormalities.7,34
Conclusion
The morphologic features observed in our patient appear to correspond most closely to the type of lesion described by Su and Person5 and Whittaker et al.6 Although our case was clinically difficult to distinguish from linear morphea, the histology suggested SMP over other causes. If our patient’s SMP progressed to the joints, physical therapy would be needed to maintain range of motion and function of the extremities,2 and mandatory long-term follow-up would be required due to the risk for relapse after discontinuation of therapy. Our case highlights the inherent difficulties in the treatment of MP. Due to limited reports of SMP and MP in the literature as well as the conflicting views regarding effective and appropriate treatment options, additional investigation of these conditions and therapeutic options are necessary to further understand this debilitating condition.
