Enhancement of the aesthetic outcome of scleroderma en coup de sabre with botulinum toxin injection

Abstract

Linear scleroderma is a rare form of localized scleroderma. The involvement of the frontal or frontoparietal region with linear scleroderma is called en coup de sabre (ECDS). ECDS presents as linear sclerotic depressed groove appearing on the frontoparietal region. It is usually unilateral and extends from the forehead into the frontal scalp. Its paramedian location is more common than its median one. The sclerotic changes affect the soft tissue and muscles as well as adjacent structures.1 Linear scleroderma has diverse etiologies, and its pathogenic mechanism is still unclear. Botulinum toxin (BTX) is an exotoxin produced from Clostridium botulinum. It blocks the release of acetylcholine from the cholinergic nerve end plates, resulting in inactivity of the muscles or glands innervated. It has gained a great interest in cosmetic dermatology for its effects on hyperkinetic facial lines and focal hyperhidrosis.2 Recently, BTX has also been used experimentally in many noncosmetic dermatologic conditions with agreeable results.2 We present 2 patients with disfigurement-associated ECDS treated successfully with BTX injection.