Circumscribed Morphea and Breast Asymmetry in an Adolescent

Morphea is a rare fibrosing disorder of the skin and underlying tissues. Circumscribed morphea presents with less than three discrete indurated plaques and breasts are commonly affected in women. We report the case of a 12-year-old female with a right infra-areolar, nontender, brownish patch and asymmetry of the right breast with 2 years of evolution. Skin biopsy showing thickening of the dermal collagen bundles confirmed the clinical diagnosis of morphea. After a 3-year follow-up period without progression of disease, reconstructive surgery is scheduled. Plaque morphea can involve all layers of the skin but associated breast deformity is rare. It can mimic benign and malignant breast disorders justifying the benefit for early tissue biopsy. Breast morphea generally has a good prognosis but hyperpigmentation and breast deformity in young girls have been rarely described. An early diagnosis can possibly lead to a therapeutic intervention with a different outcome, as it can be the source of severe psychological and social issues in a delicate period of development such as adolescence. 1. Introduction Morphea is a rare fibrosing disorder of the skin and underlying tissues, with equal prevalence both in adults and children, female predominance, and greater prevalence in caucasians. Circumscribed morphea presents with less than three discrete indurated plaques, predominantly on the trunk, and it can be superficial or deep [1–3]. Breasts are commonly affected in women, uniformly sparing the nipples [4]. 2. Case Presentation We report the case of a 12-year-old female patient who was referred to our outpatient clinic for evaluation of a patch in her right breast with 2 years of evolution. Pruritus and pain were denied. No musculoskeletal, respiratory, gastrointestinal, neurologic, and vascular symptoms were present. Her past medical history was irrelevant except for asthma and there was no family history of autoimmune diseases. At the physical exam, right breast asymmetry was noted, with an infra-areolar patch with 7 by 3？cm, with nontender, brownish, hyperpigmented, and hypopigmented areas (Figure 1). There were no other relevant cutaneous lesions. Figure 1: Right breast asymmetry, infra-areolar patch, with 7？cm, with nontender, brownish, hyperpigmented, and hypopigmented areas. A skin biopsy was performed, showing thickening of the collagen bundles in the dermis with a perivascular lymphohistiocytic infiltrate. No eccrine glands were present (Figure 2). These histologic findings confirmed the clinical diagnosis of morphea. Figure 2: Haematoxylin and