At a Glance - Plaque-type morphea vs Becker naevus

Contributed by Dr Jean Watkins, a sessional GP in Hampshire.

Plaque-type morphea (localised scleroderma).
Plaque-type morphea

Aetiology

  • Cause unknown but occasionally follows injury, pregnancy, viral infections or autoimmune disease.
  • Results from excessive deposition of collagen that leads to thickening of the dermis, and/or subcutaneous tissues.
  • Commonly presents before the age of 18 but may appear at any age. More common in women.

Clinical features

  • Single or multiple circumscribed, indurated, round or oval plaques, asymmetrical and of variable size (1-20cm).
  • May occur anywhere but more commonly the abdomen, breasts or thighs.
  • Initially mauve colour but later shiny white central area with loss of hair follicles and sweat glands. May become brown.
  • May persist for several years (usually up to three to five years but may be much longer) before softening and resolving spontaneously. A brown stain may remain.
  • A diagnosis can normally be made on clinical grounds; if necessary confirmed by biopsy.
  • No specific treatment is known to treat this condition. Potent topical or intralesional steroids may help to reduce inflammation and prevent progression.

Becker naevus
Becker naevus

Aetiology

  • Late-onset epidermal naevus.
  • Usually occurs in males in prepubertal period to late teens.
  • Cause unknown but thought possibly to be related to a gene defect and triggered by androgens.

Clinical features

  • Patient presents with the appearance of a unilateral, flat, brown patch, usually in the shoulder region or upper chest.
  • May gradually extend for some years, thicken and develop hairs in the area.
  • Acne may develop in the naevus.
  • Diagnosis may be confirmed by biopsy.
  • Treatment is unnecessary unless for cosmetic reasons.
  • Patients should be advised to avoid sun exposure as it will increase the discolouration.
  • Laser or electrolysis may be used to remove hairs. Laser treatment can improve pigmentation but can occasionally worsen the condition.

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