Keloid-like morphoea

Abstract

Conflict of interest: none declared. An 11‐year‐old Bangladeshi girl presented with a 1‐year history of a hyperpigmented patchy eruption involving her arms, neck, trunk and proximal thighs. The linear plaques over her lower abdomen were slightly sclerotic and more infiltrative (Fig. 1). Her previous medical history was unremarkable, with achievement of normal developmental milestones and completed immunizations. Laboratory investigations showed that the patient was mildly positive for rheumatoid factor (titre of 1 : 40), but negative for antinuclear and anticentromere antibodies. Renal and liver function tests, iron studies, thyroid profile, full blood count, and tests for human immunodeficiency virus and human T‐lymphotropic virus were normal or negative. Magnetic resonance imaging scams of the pelvis, abdomen and chest were unremarkable, and tissue T‐cell rearrangement studies did not identify any monoclonal T‐cell expansion. On histological examination of initial biopsy samples taken from the upper arm and abdomen, dense, thickened dermal collagen fibres were seen throughout the upper dermis, extending into the lower dermis. There were small aggregates of lymphocytes and plasma cells around the deeper dermal vessels. There were no granulomas or histiocytic cell infiltrates. Stains for fungi, parasites and acid‐fast bacilli were all negative.