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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.
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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.
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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 (firstname.lastname@example.org).
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.
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