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| THROUGH THE DERMOSCOPE |
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| Year : 2019 | Volume
: 10
| Issue : 1 | Page : 92-93 |
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Dermoscopy of morphea
Yasmeen Jabeen Bhat, Saniya Akhtar, Iffat Hassan
Department of Dermatology, Government Medical College Srinagar, Karan Nagar Srinagar, Jammu and Kashmir, India
| Date of Web Publication | 14-Jan-2019 |
Correspondence Address:
Yasmeen Jabeen Bhat
Department of Dermatology, Government Medical College Srinagar, Karan Nagar Srinagar - 190 010, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/idoj.IDOJ_350_17
How to cite this article:
Bhat YJ, Akhtar S, Hassan I. Dermoscopy of morphea. Indian Dermatol Online J 2019;10:92-3 |
A 28-year-old female presented with an area of thickening and hypopigmentation of the skin over the left side of her neck for 2 years [Figure 1]. She gave history of reddish discoloration of the skin initially which slowly started thickening and became hypopigmented. She had applied several topical medications for the same. On examination, there was an oval hypopigmented indurated plaque over the left side of the neck with the surrounding skin showing hyperpigmentation.
Dermoscopic examination of the lesion was done (Dermlite DL3N, California USA, 10×). In the polarized mode, there were whitish fibrotic beams with linear branching vessels crossing the beams [Figure 2]a. It is important to differentiate the pattern of vessels in morphea from cases of steroid abuse where the vessels are mostly telengiectatic compared to linear branching vessels in morphea crossing the white fibrotic beams. In addition, the area showed loss of hair compared to the surrounding skin, again supporting the diagnosis of morphea [Figure 2]b. Histopathological examination of the biopsy was done for confirmation of the diagnosis, which showed thinned epidermis with flattened rete ridges, minimal inflammation in the dermis with collagenization of dermis, and loss of adnexae [Figure 3]a. The papillary dermis showed homogenous collagen whereas reticular dermis and subcutis consisted of thickened closely packed hypocellular eosinophilic collagen bands with hyalinization arranged parallel to each other. Mild perivascular chronic inflammation and absence of adnexae was seen in the dermis [Figure 3]b. The white fibrotic bands correspond to the dermal sclerosis seen on histopathology, and loss of adnexae was seen both on dermoscopy as well as on histopathology. | Figure 2:(a) White fibrotic beams (blue star) crossed by linear branching vessels (black arrows). (b) Loss of hair in the involved area (green arrows) compared to adjacent area (blue arrow)(Polarized mode, Dermlite DL3N, California USA, ×10) with occasional pigment dots (red arrow)
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 | Figure 3:(a) Histopathologicalimage of the same patient showing thinned epidermis with flattened rete ridges (blue arrow), minimal chronic perivascular inflammation (red arrow) with absence of adnexae in the sections examined (H and E ×400). (b) Thick, closely packed collagen bundles in reticular dermis and subcutis with hyalinization (red star) (H and E ×400)
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Morphea is a disorder of unknown etiology which presents with localized area of skin sclerosis. The dermoscopic examination of morphea can be beneficial in cases where the diagnosis is not clear, especially in darker skin types where the typical lilac border surrounding the plaque of morphea is difficult to appreciate. Whitish fibrotic beams seen on dermoscopic examination are very specific for morphea, which are frequently crossed by linear branching vessels.[1] Furthermore, the loss of appendages is evident on the magnified examination of the lesions. Dermoscopy is helpful in differentiating between morphea and lichen sclerosus as comedo-like openings and white patches characteristic of lichen sclerosus are seen less commonly in morphea.[2],[3]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Campione E, Paternò EJ, Diluvio L, Orlandi A, Bianchi L, Chimenti S. Localized morphea treated with imiquimod 5% and dermoscopic assessment of effectiveness. J Dermatol Treat 2009;20:10-3.  |
| 2. | Tiodorovic-Zivkovic D, Argenziano G, Popovic D, Zalaudek I. Clinical and dermoscopic findings of a patient with co-existing lichen planus, lichen sclerosus and morphea. Eur J Dermatol 2012;22:143-4. |
| 3. | Shim WH, Jwa SW, Song M, Kim HS, Ko HC, Kim MB, et al. Diagnostic usefulness of dermatoscopy in differentiating lichen sclerous et atrophicus from morphea. J Am Acad Dermatol 2012;66:690-1. |
[Figure 1], [Figure 2], [Figure 3]
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