All cases in Connective Tissue Disorders

Widespread Morphea

Widespread Morphea
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A 45-year-old woman presented with indurated plaques involved large portions of  the trunk and extremities of 5 years duration. On examination, wide spread sclerotic indurated areas with hyperpigmentation were seen. Serological tests for connective tissue disease were non-reactive and skin biopsy was consistent with morphea. The patient has been treated with an oral hydroxychloroquine 400 mg/day plus topical corticosteroid.

A case presented by Dr. Ayman Abdelmaksoud, MD (Egypt).

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Cicatricial alopecia

Cicatricial alopecia
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A 24-year-old female presented with patchy alopecia of three years duration. On examination, a large oval area of cicatricial alopecia  with small red slightly scaly papules at the periphery of the bald patch were seen. No other body areas were involved. Skin biopsy taken from the periphery of the bald patch showed changes consistent with discoid lupus erythematosus.

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Extensive morphea

Extensive morphea
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A case presented by Dr. Ayman Abdelmaksoud, MD.
A 45-year-old woman presented with indurated plaques involved large portions of  the trunk and extremities of 5 years duration. On examination, wide spread sclerotic indurated areas with hyperpigmentation were seen. Serological tests for connective tissue disease were non-reactive and skin biopsy was consistent with morphea. The patient has been treated with an oral hydroxychloroquine 400/day plus topical corticosteroid.
 
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Striae distesae

Striae distesae

There are 4 causes of striae distensae:

1. Pregnancy (Stria gravidarum)

2. Obesity (Over-stretched skin)

3. Steroid induced: A. Cushing’s syndrome: Endogenous steroids excess

B. Corticosteroids (Systemic and/or topical) and sex steroid hormones : Exogenous steroids excess

4. Heavy-weight lifters (Sport): due to large muscle mass stretching the overlying skin and Occasionally there may be an additional role for anabolic steroids.

Predilection sites: generally skin overlying fat cushions (abdomen, buttocks, thighs, calf region, shoulders, over the biceps muscle and occasionally the back). Skin overlying bony areas seems to be exempted.

The presented case is a 24-year-old female presented with purplish linear atrophic areas involved many predilection sites but maximally over the calves (Photo) due to misused corticosteroids for 2 months to increase body weight.

N.B: Striae usually have purplish color in early stages (first few months) but later became narrower and whitish in color.

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Giant-cell tumour of tendon sheath

Giant-cell tumour of tendon sheath

A 39-year-old man presented with an asymptomatic, ruberry firm lobulated nodule involved the middle finger. Clinically, it fits the diagnosis of giant-cell tumor of the tendon sheath (giant-cell synovioma or localized nodular tenosynovitis). The cause is unknown and usually presents in mid-life. The nodule is usually asymptomatic, but in occasional cases there may be pain, numbness or stiffness of the digit. There is a strong association with osteoarthritis. The lesions do not regress, and they can persist for many years.

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Lupus profundus

Lupus profundus

History

          Painless deep dermal and subcutaneous nodules and plaques involving the right cheek of this lady caused unilateral facial atrophy with cup-like depression (sunken cheek) of 12 years duration. At presentation, two new dermal nodules beneath normal skin were found in the lower part of the affected area. These nodules were firm, rubbery and non tender. A deep skin biopsy was taken from one of the new nodules has showed lymphocytic panniculitis with sharply circumscribed lymphocytic nodules in the lower dermis and subcutaneous fat. Serological investigations were normal apart from raised ESR and positive ANF.
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