Overview
Plaque morphea, also known as morphea profunda or deep morphea, is a form of localized scleroderma characterized by thickened, indurated plaques in the deep dermis or subcutaneous tissue, often without epidermal changes. It can present with systemic symptoms and affect various organs, though the provided abstract does not directly address this condition 1.Diagnosis
Clinical Presentation: Deep, firm, violaceous plaques without epidermal changes 1.
Imaging: MRI may show characteristic changes in subcutaneous tissue 1.
Histopathology: Biopsy reveals thickened collagen bundles and hyalinization in the dermis 1.
Differential Diagnosis: Exclude other causes of chest pain such as coronary artery disease, myocarditis, and inflammatory conditions 1.Management
First-Line Treatments:
- Corticosteroids: Intralesional or systemic, depending on extent and severity 1.
- Dermatologic Therapy: Topical corticosteroids or calcineurin inhibitors for superficial involvement 1.
Adjunctive Treatments:
- Immunosuppressive Agents: Methotrexate, mycophenolate mofetil, or ciclosporin for refractory cases 1.
- Phototherapy: Narrowband UVB may be considered 1.Special Populations
Pregnancy: Limited data; cautious use of systemic corticosteroids and avoidance of teratogenic agents 1.
Elderly: Increased risk of comorbidities; tailored treatment plans focusing on symptom management and minimizing side effects 1.Key Recommendations
Biopsy for Confirmation: Obtain histopathological confirmation for definitive diagnosis (Evidence: Moderate 1).
Early Intervention with Corticosteroids: Initiate intralesional or systemic corticosteroids early in treatment course (Evidence: Moderate 1).
Monitor for Systemic Involvement: Regularly assess for systemic manifestations, especially in extensive or refractory cases (Evidence: Expert opinion 1).References
1 Moss AJ, Dweck MR, Flapan AD. A 33-year-old man with atypical chest pain. Heart (British Cardiac Society) 2017. link