Nodular Scleroderma Revisited: Systemic Sclerosis Presenting as Annular Keloidal Sclerotic Plaques

Area of Science:

• Dermatology
• Rheumatology
• Pathology

Background:

• Nodular scleroderma is an uncommon manifestation of systemic sclerosis.
• It is characterized by firm, keloid-like plaques or nodules.

Observation:

• A case study describes a patient with undiagnosed systemic sclerosis presenting with nodular scleroderma.
• Literature review included searches for keloidal scleroderma, nodular scleroderma, and systemic sclerosis.

Findings:

• Nodular scleroderma lesions mimic keloids and are typically found on the upper trunk and arms.
• Pathological examination reveals features of scleroderma, keloid, or hypertrophic scarring.
• Hypothesized pathogenesis involves a keloidal response in genetically predisposed individuals within the fibrotic process of systemic sclerosis.

Implications:

• Systemic sclerosis should be suspected in patients with nodular or keloidal plaques resembling morphea, particularly with concurrent systemic symptoms.
• Histological findings of scar or keloid in such lesions warrant further investigation for systemic sclerosis.
• Timely diagnosis of nodular scleroderma is crucial for managing associated systemic sclerosis complications.