CASE REPORT
A 26-year-old Black female with a history of Raynaud’s syndrome presented with complaints of a pruritic dermatitis on the right abdomen, right thigh, and chest. She noted that it first began on her right thigh 1.5 years prior and, more recently spread to her chest and neck. She denied any pain or tenderness or any prior dermatitis or trauma. She endorsed a family history significant for systemic lupus erythematous in her aunt.
Physical exam findings revealed dark brown to violaceous, smooth, well-demarcated, indurated, and hypertrophic plaques and dark brown patches on her upper chest, right neck, abdomen, right thigh, bilateral flanks, and suprapubic region.
A punch biopsy revealed marked cellular fibroplasia with a proliferation of capillaries and fibroblasts. CD34 staining showed a decrease in dermal dendritic cells. Histopathologic findings showed dermal fibroplasia, consistent with scar possibly related to keloid formation. Repeat biopsy revealed a diffuse fibrosing process with features of a hypertrophic scar and loss of the CD34 dermal dendritic cell network, as well as sclerosis into the subcutaneous septae. Through her combined clinical presentation and histopathology, she was diagnosed with keloidal morphea. Topical treatment was initiated with a combination of topical clobetasol and calcipotriene cream with a plan to add intralesional steroid injections. The patient was also advised to follow up with rheumatology for further
