Generalized radiation-induced morphea: a rare effect of radiotherapy, distinguished from postirradiation fibrosis

Radiation-induced morphea is a rare and under-recognized autoimmune reaction of the subcutaneous connective tissue which can be triggered by exposure to ionizing radiation. It is often wrongly diagnosed as chronic radiodermatitis or radiation fibrosis. This can lead to delayed diagnosis and treatment, leading to poorer outcomes such as chronic pain issues. We report a case of a 66-year-old female with a history of tumorectomy for invasive ductal carcinoma of the left breast who underwent adjuvant radiotherapy. Eight months later, she presented with multiple plaques at previous surgery sites and others, which underwent biopsy confirming a diagnosis of plaque morphea. She was treated with corticosteroid bolus therapy combined with methotrexate, resulting in significant improvement. Delineating between generalized radiation-induced morphea and postirradiation fibrosis is pivotal for precise diagnosis and tailored treatment strategies, fostering improved patient outcomes and quality of life.