Under the Surface: A Rare Case of the En Coup De Sabre Subtype of Linear Morphea in the Rio Grande Valley

Localized scleroderma, also referred to as 'morphea,' is a rare autoimmune disorder that affects the superficial layers of the skin and is characterized by both erythematous and bruise-like lesions with signs of central skin tightening or sclerosis; deeper lesions may be identified as edematous, erythematous plaques in the absence of well-defined borders. A subtype named en coup de sabre (ECDS) exists in the classification of linear morphea and presents with a linear induration on either the face or scalp. Our patient is a 21-year-old Hispanic female initially residing outside of the South Texas region who experienced an onset of skin thickening and blisters on her right leg in April of 2023 after returning from Europe. Initially, she was diagnosed as having stasis dermatitis, but due to progression of her cutaneous symptoms, a skin biopsy was performed in September of 2023, which confirmed a diagnosis of morphea. After 10 months of initial treatment with a dermatologist outside of South Texas, she presented to the UT Health Rio Grande Valley (UTRGV) dermatology specialty clinic (Edinburg, TX, USA) with new and evolving skin plaques across her body, along with a forehead lesion that was consistent with the ECDS subtype of linear morphea. During this time, care was also formally established with local rheumatology and wound care specialists who had a pivotal role in the management of her condition. This case discusses the variability in clinical presentation of morphea, its mixed nature of lesions, its progression, its varied response to medical therapy, and the need for multidisciplinary management.