Skin change on forehead
A 41-year-old Hispanic woman noticed a change in the skin of her forehead over the past 3 years. Her forehead didn’t hurt or itch, but she was concerned about the changes to her skin. She was otherwise in good health and wasn’t taking any medications.
What's your diagnosis?
We diagnosed linear morphea. The pattern running down the patient’s forehead is called “en coup de sabre” meaning the blow of a sword. While the differential diagnosis could include lichen sclerosis and discoid lupus, her pattern was very specific for linear morphea. Linear morphea does not cause any health risks to the patient and is merely a cosmetic issue.
We told the patient that her treatment options included high-potency topical steroids and topical calcipotriol. Other options include ultraviolet-A light therapy and oral methotrexate. The combination of high-dose systemic steroids and low-dose methotrexate has also been used successfully in some cases. The patient took a prescription for topical calcipotriol and said she would fill it if her insurance covered the medication.
Photos and text for Photo Rounds Friday courtesy of Richard Usatine, MD. This case was adapted from: Mayeaux EJ. Scleroderma and morphea. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:539-544.
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