Corrugated Indurated Short Cords on the Neck of a Teenage Girl | Adolescent Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Corrugated Indurated Short Cords on the Neck of a Teenage Girl

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A teenage girl presented with a 1-year history of multiple indurated cords on the anterior neck area. The lesions appeared without an identifiable cause and spread around the neck. The cords eventually covered the entire anterior neck and upper and lower clavicle areas. The skin lesions formed a corrugated pattern at the time of presentation. The patient had previously been treated with moisturizers at a local clinic for 2 months without any signs of improvement. The patient denied any manipulation or trauma at those sites. There was no personal or family history of keloid formation. The girl was otherwise healthy and met normal developmental milestones.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

B. Morphea

Skin biopsy results revealed atrophy of adnexal structures, closely spaced thick bundles of collagen that were organized parallel to the epidermis in the middle and lower part of the dermis, and sparse superficial perivascular inflammation (Figure, C and D). Inspection of the Weigert elastic stain showed reduction of elastic fibers. All laboratory test results, including routine hematological examination, liver and kidney function tests, and autoantibody screening, were within normal limits. The combination of results from clinical tests, histologic examination, and auxiliary investigation led to the diagnosis of morphea.

Because there was neither evidence of systemic involvement nor deep involvement or potential disfigurement, the girl was treated with topical mucopolysaccharide polysulfate cream twice daily and with 0.1% tacrolimus ointment once daily. After 6 weeks of treatment, the skin lesions had softened, and there were no new lesions. After a 6-month telephone follow-up, the patient reported that the skin lesions had improved.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Li-Tao Zhang, MD, PhD, Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, 354 Beima Rd, Hongqiao District, Tianjin, China (zhanglitao@medmail.com.cn).

Published Online: April 14, 2021. doi:10.1001/jamadermatol.2021.0433

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this article.

References
1.
Careta  MF , Romiti  R .  Localized scleroderma: clinical spectrum and therapeutic update.   An Bras Dermatol. 2015;90(1):62-73. doi:10.1590/abd1806-4841.20152890PubMedGoogle ScholarCrossref
2.
Laxer  RM , Zulian  F .  Localized scleroderma.   Curr Opin Rheumatol. 2006;18(6):606-613. doi:10.1097/01.bor.0000245727.40630.c3 PubMedGoogle ScholarCrossref
3.
Rencic  A , Brinster  N , Nousari  CH .  Keloid morphea and nodular scleroderma: two distinct clinical variants of scleroderma?   J Cutan Med Surg. 2003;7(1):20-24. doi:10.1177/120347540300700104 PubMedGoogle ScholarCrossref
4.
Tomasini  C .  Cordoniform morphea: a clinicopathologic study of two cases presenting with the rope sign.   J Cutan Pathol. 2016;43(7):613-622. doi:10.1111/cup.12704 PubMedGoogle ScholarCrossref
5.
Kauer  F , Simon  JC , Sticherling  M .  Nodular morphea.   Dermatology. 2009;218(1):63-66. doi:10.1159/000173976 PubMedGoogle ScholarCrossref
6.
Ohata  C , Yasunaga  M , Tsuruta  D ,  et al.  Nodular morphea (NM).   Eur J Dermatol. 2013;23(1):87-93. doi:10.1684/ejd.2012.1893 PubMedGoogle ScholarCrossref
7.
Roach  ES , Islam  MP .  Pseudoxanthoma elasticum.   Handb Clin Neurol. 2015;132:215-221. doi:10.1016/B978-0-444-62702-5.00015-9 PubMedGoogle ScholarCrossref
8.
Arora  H , Falto-Aizpurua  L , Cortés-Fernandez  A , Choudhary  S , Romanelli  P .  Connective tissue nevi: a review of the literature.   Am J Dermatopathol. 2017;39(5):325-341. doi:10.1097/DAD.0000000000000638 PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close