Keloidal Morphea: A Rare Variant Presenting as a Diagnostic Challenge
Chourouq Mustapha Eid *
Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Fatima Ezzahraa Sassine
Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Hyba Taounza
Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Manal El Beyeg
Department of Pathology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Taha Aaboudech
Department of Pathology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Kaoutar Znati
Department of Pathology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Mariame Meziane
Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Nadia Ismaili
Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Laila Benzekri
Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background and Aims: Keloidal morphea, also referred to as nodular scleroderma, is an extremely rare variant of localised scleroderma characterised by keloid-like nodules developing within sclerotic skin lesions. Because of its rarity and clinical resemblance to keloids, it may represent a significant diagnostic challenge. We describe such a case and underline its diagnostic pitfalls.
Presentation of Case: A 40-year-old woman presented with multiple hyperpigmented sclerotic plaques involving the trunk, back, axilla, and upper limbs that had progressively evolved over 10 years. Firm keloid-like nodules, some with pseudopod-like extensions, developed within these plaques. There was no history of trauma or keloid formation and no clinical or serological evidence of systemic sclerosis. Histopathological examination revealed dermal fibrosis with thickened collagen bundles arranged in a sclerotic pattern, consistent with morphea and keloidal change.
Discussion: The patient was treated with systemic corticosteroids combined with methotrexate, but no significant clinical improvement was observed after six months of therapy, in keeping with the frequently reported therapeutic resistance of this condition.
Conclusion: This case highlights the importance of recognising keloidal morphea as a rare variant of morphea and of considering it in the differential diagnosis of keloid-like lesions, particularly in patients without known risk factors for keloid formation.
Keywords: Dermatopathology, keloidal morphea, keloid-like lesions, localized scleroderma, nodular scleroderma