Morphoea

Morphoea, formerly called Addison's keloid, is a chronic cutaneous affection, characterized by the appearance of one or more discrete spots or patches, usually isolated and roundish in form, pinkish in color, and slightly elevated when hyperaemic and hypertrophic, surrounded by a tinted or violaceous border, later becoming whitish, anaemic, atrophic, and slightly depressed; and upon their surface, in the early stage, may be seen small streaks of dilated blood-vessels.

Forms. - This rather infrequent affection assumes various definite forms, according as the character of its development is mainly hypertrophic or atrophic.

Patches of the first form, which are mainly hypertrophic, enlarge until they are of the size of small or large coins, and are roundish in outline; after a preliminary hyperaemic stage, they gradually assume a lardaceous appearance, and later on show a distinct atrophic aspect.

Lesions of the second form, which is mainly atrophic, manifest little or no tendency to hyperplasia, and occur in small, pit-like, or slightly depressed, cicatriform or telangiectasia, isolated or grouped spots or streaks, forming maculae et striae atrophicae.


Symptoms. - A typical case of morphoea usually makes its appearance by the formation of one or more roundish, circumscribed, hyperaemic, slightlv elevated macules or patches, varying in diameter from one-quarter to a couple of inches; the centre gradually whitens, and is bordered by a tinted circle of violaceous or pinkish hue, composed of dilated capillaries, and often there is to be seen a plexus of small blood-vessels extending upon the surface of the lesion. The hyperaemia of the patch is soon succeeded by an anaemic state, which may be sometimes so decided as to cause a slight depression of the surface. The patch, from this time, undergoes a gradual change until it presents the characteristic smooth, lardaceous appearance, resembling inlaid wax, or old ivory. The connective tissue of the skin is increased and becomes condensed. The activity of its process of development becomes lessened during this stage of the disease and enters on a chronic course. The skin of the patch may be soft, or quite firm and inelastic.


In its further progress the affection may manifest atro-phic changes in the tissues as well as of the glands and vessels of the affected skin, resulting in contraction and also depression of its surface, together with a lessening or cessation of the secretions of the sweat and sebaceous glands; and the skin feels stretched and thinned. These later changes may extend over a period of years and become permanent, or the affection, before it has become decidedly atrophic, sometimes displays its tendency to recovery by the disappearance of the lesion.

The distribution of the lesions is symmetrical, and has been found upon various regions of the body, as upon the face, chest, back, buttocks, arms, and thighs. The shape of the patches, even in individual cases, is irregular, and varies, being round or elongated, but usually roundish.
In its early stage, morphoea develops usually without any or with but slight attending subjective symptoms; later there may be more or less anaesthesia.