Clinical Challenge: Hypopigmented Site on Mid-Back of Teenager

This diagnosis was confirmed by biopsy and a detailed history and physical exam was needed. Localized morphea as in this case is presented with a large macule with stark hypopigmented center and lighter violaceous zone on border. Skin in the center...

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This diagnosis was confirmed by biopsy and a detailed history and physical exam was needed. 

Localized morphea as in this case is presented with a large macule with stark hypopigmented center and lighter violaceous zone on border. Skin in the center of the macule has lost its elasticity. The texture in this area is also very smooth and lost any textural characteristics.

This patient was screened for systemic involvement including CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasis). She screened negative for these conditions. 

Further questioning was also negative with regards to; any GI/GU symptoms, respiratory symptoms, joint pain or stiffness. Her preliminary labs included, CBC, CMP, ANA, UA, antiscleroderma AB, Anti DS DNA AB, Anti smith AB, Anti RNP. 

Her ANA was positive with a titer that confirmed scleroderma; all other labs were normal. Treatment for this patient consisted of a class 1 steroid twice daily for 4 weeks and a recommendation to eliminate tanning.

At the four-week follow-up, her tan had resolved, the macule was much smaller in diameter, and skin texture was returning.

— David S. Davidson, MS, PA-C
President, New Jersey Dermatology PA Society; Physician Assistant, Family Dermatology, Freehold and Colts Neck, NJ