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A 71-year-old man reported a 30-year history of sclerotic plaques over his chest and upper back. For the last 20 years he had experienced complete baldness and a progressive hardening and contraction of the skin of the scalp. Over the last 2 years he had developed ulcerations on the scalp. He had no Raynaud symptoms and no signs of systemic sclerosis. He also had a 4-year history of atrial fibrillation and a 6-month history of rheumatoid arthritis.
Physical examination revealed hypopigmented, sclerotic, and scarlike atrophic skin on the scalp, forehead, and nose, translucent veins, and almost complete absence of elasticity (Figure 1). In the parietal, occipital, and retroauricular areas were several rock-hard ulcers with a yellowish eschar and erythematous border (Figure 2). Across the chest was a butterfly-shaped yellowish sclerotic plaque with a velvety surface and discrete follicular keratosis. A similar plaque was present in the middle of the upper back.
Herzinger T, Prinz JC, Röcken M. Pansclerotic Morphea of the Head. Arch Dermatol. 2008;144(1):125-126. doi:10.1001/archdermatol.2007.18