Patrick Condry M.D., Clinical Asst Professor, Dept Dermatology, University of Rochester, Rochester, NY, USA on September 3, 2008
This is always a tough problem. I had one partial response to cyclosporin which was not in your list of alternatives for therapy. I have never had one completely responded to therapy and many have gone to Plastics for repairs!
Arshad Khan M.D., Consultant Dermatologist, Peshawar, Pakistan on September 3, 2008
I have treated few linear morphoea patients with topical calcipotriol and MTX with good results. If she wants pregnancy, she should be advised to either delay it of just use topicals, which should be safe.
Khaled El-hoshy M.D., Consultant Dermatologist, Troy, Michigan, USA on September 3, 2008
Balloon tissue expansion & closure is one of the options
if available. Autologous fat transfer can offer some improvement.
The new filler Macrolane, by Q-med may also prove useful.
Omid Zargari, M.D., Consultant Dermatologist, Rasht,
Iran on September 4, 2008
Great photos. I had one case with reasonable response to a
combination of low dose dexa, topical calcipotriene, pentoxifylline
and vitamine E. I don't know which one did the job!, but the
outcome was quite acceptable.
Azar Maluki, M.D., Asst. Professor, Dept Dermatology,
College of Medicine, University of Kufa, Al-Najaf, Iraq
on September 4, 2008
This condition is very challenging for both the patient and
doctor. I had treated many such cases with very good impressive
results using topical combination of clobetasol prop., retinoid
cream 0.1% and alpha hydroxy acid cream . The response was better
with the addition of penicillamine caps. and systemic steroids.
On stabilization of the case, many cosmetic alternatives would
be available eg. injections of dermal fillers like Hydrogell
(Aquamid).
During pregnancy, topical drugs would be a safe option.
Pakhi Pereira, M.D. Consultant Dermatologist, Bangalore, India on September 4, 2008
Is this case still progressing? If she has stabilised, you might try dermal fillers after subscission for a good result.
Nidal Dabbour, M.D. Consultant Dermatologist, Saudi Arabia on September 4, 2008
I think this patient should receive intralesional steroids to be given superficially in the dermis and not in the remaining fat tissue so that the depth of the lesion will not increase. Steroids will halt the inflammatory process which is very mild perivascular B lymphocytes and few plasma cells. Steroids will also dissolve the deposited collagen that replaced the fat tissue. Surgical excesion is a good choice if steroids failed
Bushan Kumar M.D., Professor, Former Head, Dept Dermatology, PGIMER, Chandigarh, India on September 4, 2008
In case of an established sclerotic plaque nothing works except
surgical excision. In an evolving lesion, topical calcipotriol
and low dose methotrexate given over a period of 6 months to
1 year does help. All other therapies in my view are hardly
of any help.
Stelios Minas, M.D., Consultant Dermatologist, Limassol,
Cyprus on September 5, 2008
Usually I treat cases like that with inj. Penicillin (1.2 m
ui /10 inj)and after that some courses (1-2 months) with plaquenil
and trental. As a topical treatment I use microinjection of
trental and longidasa . I have seen some effect in some patients.
If the effect is insufficient than I refer the patient to plastic
surgery for surgical excision.
Jon Robitschek, M.D., Resident, Tripler Army Medical
Center, Honolulu, HI, USA on September 5, 2008
Excellent presentation. In our published case we had excellent cosmesis from the use of Alloderm which was followed 18 months postoperatively.
Ref: Robitschek J, Wang D, Hall D. Treatment of linear
scleroderma "en coup de sabre" with AlloDerm tissue
matrix. Otolaryngol Head Neck Surg. 2008 Apr;138(4):540-1.
Firas Altamimi M.D., Basra Teaching Hospital, Basra, Iraq on September 5, 2008
Nice pictures. The depressed scar need good cosmetic change for her face. I think she could be treated either by topical halofuginone or by CO2 vaporization laser. Topical halofuginone is one of new treatment that is used in local scleroderma and act as inhibitor of type 1 collagen through inhibition of NF-(kappa)B and p38(member of MAPK family). CO2 vaporization is only used if the scleroderma is associated with calcinosis cutis.
Amin Nurul M.D., Professor of Dermatology, Armed Forces
Medical College, Dhaka, Bangladesh on September 8,
2008
Excellent photos and presentation. I have treated one case
with topical calcipotriol and topical corticosteroid and in
another case with topical calcipotriol and pentoxyphylline.
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