Clinical and Histopathological Evaluation of Pigmented Morphea with New Insight in Relation to Etiopathogenesis of the Disease

Background Morphea is an autoimmune disease where there are early erythematous patches with or without lilac border and ending with sclerosis. While in Iraqi population, morphea patients present with pigmented patches that might stay for a long time before changing into sclerotic ivory white plaques. The objective of this study is to do clinical and histopathological evaluation of different stages of morphea. This is a descriptive study that was conducted in Medical city, Baghdad, where 100 patients with morphea were included. Clinical and histopathological evaluation was carried out. Results Their ages ranged from 2 – 60 years old with M±SD=26.24±15.345, and female to male ratio 1.5: 1. In all cases, the lesion started as pigmented, non-indurated areas that might stay for several months and even years before progressing into ivory white sclerotic plaques. The histopathological changes in morphea could be classified into early pigmented phase where there was mild acanthosis, increase in basal melanosis, vascular dilatation and massive deposition of collagen together in the dermis and panniculus. While in late cases especially with sclerosis there was in addition thinning and atrophy of epidermis with basal liquefaction plus homogenization and hyalinization of collagen in papillary dermis simulating lichen sclerosus. Conclusion this study shows striking clinical and histopathological findings as all cases presented with pigmented patches that are compatible with histopathological changes where there was collagen deposition with basal hyper melanosis in early cases, with thinning of epidermis and homogenization of papillary dermis in late cases