Clinical Images: Unilateral skin induration and pigmentation: a case of generalized morphea

The patient, a 40-year-old woman, presented with progressive skin tightening and hyperpigmentation confined to the right side of her body for 14 months. An examination revealed indurated plaques with overlying hyperpigmentation and scattered erythematous papules (A). A laboratory evaluation showed elevated values for D-dimer, the erythrocyte sedimentation rate, IgG, and rheumatoid factor, with low complement levels. Antinuclear and anti–double-stranded DNA antibodies were positive. A skin biopsy from the right leg revealed thickening and homogenization of collagen fibers in the deep dermis and subcutis, consistent with morphea (B). The diagnosis of unilateral generalized morphea was made. She was initially treated with glucocorticoids, but persistent symptoms prompted initiation of tocilizumab, with subsequent gradual clinical improvement. This rare presentation underscores the importance of considering generalized morphea in patients with unilateral skin induration and pigmentation. The authors thank the patient for her consent to share this case and the medical staff involved in her care. Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.