Morphea profunda

In the view, “morphea profunda” is the most appropriate term and “eosinophilic fasciitis’ is part of the same spectrum because of deeper involvement and more pronounced inflammatory‐cell infiltrate.

Abstract

Biopsy specimens from 23 patients with deep, bound-down, sclerotic plaques or diffuse zones of sclerosis were studied histologically. All showed thickened and hyalinized fibrous tissue in the region of the subcutis. In 11 patients the biopsy specimens were deep enough to include fascia and muscle. The predominant histopathologic features were 1) thickening and hyalinization of collagen bundles in the deep dermis; in the septa of the subcutis; in the fascia 2) a moderate to marked inflammatory-cell infiltrate composed mostly of lymphocytes and situated about small blood vessels and interstitially; and 3) slight deposits of mucin. The changes in the fascia were indistinguishable from those in the subcutaneous tissue. Eosinophils were found in biopsy specimens from five patients, but in only one of these were they numerous, i.e., up to 5 per high-power field. The lesions in each of our cases were deep in the skin clinically, and they showed histologic features similar to those described previously as "eosinophilic fasciitis." However, the fascia or subcutaneous tissue is not the only tissue involved and peripheral or tissue eosinophilia is not a constant finding. In our view, "morphea profunda" is the most appropriate term and "eosinophilic fasciitis" is part of the same spectrum. The histopathologic changes in morphea profunda differ from those of conventional widespread morphea because of deeper involvement and more pronounced inflammatory-cell infiltrate.