A Case of Morphea (Localized Scleroderma)

Abstract

A 48-year-old, single woman initially presented with a solitary, rounded lesion in the gluteal region that, over the course of one year, progressed to involve the inguinal area, abdomen, and both upper and lower extremities, ultimately affecting a large proportion of the body. Lesions began as inflammatory erythematous plaques and subsequently evolved into shiny, sclerotic plaques with eventual central hypopigmentation and atrophy. Clinical and histopathological findings were consistent with localized scleroderma (morphea) of a generalized/pansclerotic phenotype. The disease course was accompanied by hair loss and weight gain and was associated with psychosocial deterioration. Systemic immunomodulatory therapy with methotrexate plus systemic corticosteroid (prednisone) was initiated; following treatment, the patient developed depressive symptoms attributed in part to medication-related adverse effects, and psychiatric management with sertraline combined with a low-dose antipsychotic (aripiprazole) resulted in clinical improvement. Neurological imaging and cardiac and basic pulmonary assessments were largely unremarkable, and no further pulmonary investigations were performed in the absence of respiratory symptoms. This case highlights the potential for extensive cutaneous and extracutaneous involvement in generalized morphea and underscores the importance of multidisciplinary follow-up, proactive management of treatment-related psychiatric morbidity, and routine psychosocial assessment to optimize adherence and quality of life.