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Deep morphea.

Isabel Bielsa¹, Aurelio Ariza

¹Department of Dermatology, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Barcelona, Spain. ibielsa.germanstrias@gencat.net

Seminars in Cutaneous Medicine and Surgery

|June 5, 2007

Summary

Deep morphea involves inflammation and sclerosis in deeper skin layers and tissues. Distinguishing between subtypes like morphea profunda and eosinophilic fasciitis is challenging due to overlapping features and histology.

Area of Science:

Dermatology
Rheumatology
Pathology

Background:

Deep morphea comprises conditions with inflammation and sclerosis affecting deep dermis, panniculus, fascia, or muscle.
Includes morphea profunda, eosinophilic fasciitis, and disabling pansclerotic morphea of children.
Distinguishing these entities is difficult due to overlapping clinical and histological features.

Purpose of the Study:

To review the clinical spectrum and diagnostic challenges of deep morphea.
To highlight associated systemic findings and laboratory abnormalities.
To discuss current, albeit nonstandardized, treatment approaches.

Main Methods:

Review of literature on deep morphea and related conditions.
Analysis of clinical presentations, histological findings, and diagnostic criteria.

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Synthesis of information on associated complications and treatment outcomes.

Main Results:

Deep morphea conditions share similar inflammatory and sclerotic histological findings, differing mainly in depth.
Clinical overlap makes precise classification challenging.
Associated symptoms like arthralgias, contractures, and carpal tunnel syndrome are common.
Visceral complications (pulmonary, esophageal, cardiac) are rare but reported.
Laboratory findings may include eosinophilia, hypergammaglobulinemia, elevated ESR, and autoantibodies.

Conclusions:

Deep morphea represents a spectrum of related disorders with overlapping characteristics.
Accurate diagnosis requires integrating clinical, histological, and sometimes systemic findings.
Treatment remains nonstandardized, with potential benefits from UVA irradiation, anti-inflammatory, and immunosuppressive agents.