Localized Scleroderma

Clinical Background:

A 43 year old male patient reported having a sclerodermic plaque in the lumbar area for approximately one year. In the same period some annular erythematous areas on the thighs and buttocks were noted.
The latter extended to form large circular shapes, continuously modified by the regression of some areas and the appearance of new plaques merging together to form wide polycyclic patterns.
Several cultural examinations previously performed by the patient's G.P. did not allow to isolate dermatophytes or other pathogens.
Furthermore, local antimycotic treatment had not altered the clinical evolution of the rash.
Physical examination revealed a wide morphea plaque in the left lumbar region with characteristically thickened, taut skin with an ivory white smooth surface, surrounded by a lilac ring.
Annular erythematous lesions, some of which forming incomplete rings, slightly raised with fine scaling, were present on the thighs and buttocks (superficial gyrate erythema).
Laboratory investigations, radiological and echotomographical exams did not disclose any signs of infectious, parasitic, neoplastic or other systemic disease.
He was started on griseofulvin (500 mg/d) with prompt resolution of the gyrate erythema. Six months later the morphea plaque was stationary.

Comment:

The association of morphea and gyrate erythema is probably incidental rather than being the expression of a common pathogenetic substrate.