Alopecia areata, morphea and psoriasis

Morphea, also called localized scleroderma, is a benign skin condition that affects only the skin and gradually resolves in 3 to 5 years, even spontaneously. It presents classically as an indurated, annular plaque with a peripheral lilac ring [1]. Alopecia areata is a cause of non-scarring hair loss and it affects the skin by T-cell-mediated autoimmunity, though the exact pathogenesis is still unclear. It can be associated with other diseases including psoriasis [2]. Psoriasis is a common, inflammatory skin disorder characterized by scaly erythematous plaques and it can be associated with numerous diseases due to its immune-mediated effects [3].
We report a morphea case that had been diagnosed accompanying psoriasis and also alopecia areata. The coexistence of morphea, alopecia areata and psoriasis was not reported in the literature before.
A 36-year-old female patient referred for evaluation of violaceous and depressed appearance on both the legs that were noticed by her 1 year before (fig. 1). She has had a psoriasis history for 10 years (and alopecia areata for 6 months (fig. 2). She does not have family history of a dermatological disease. At the dermatological examination, there were many various shaped and sized violaceous or brownish patches on the thighs and gluteal region. She had alopecia areata on the scalp. Her psoriatic lesions were in the post-inflammatory phase and limited on the knees and elbows. The PASI score was calculated as 1.8. Her routine laboratory tests including complete blood count, glucose, liver enzymes, urea, and creatinine were normal. Antinuclear antibody (ANA), rheumatoid factor, anticentromere antibodies, anti-TOPO-1 and anti-CCP antibodies were negative. Biopsy was taken from the violaceous depressed area on the left thigh. Histopathological examination showed that densely packed collagen bands in the deep reticular dermis presented parallel to the dermoepidermal junction (fig. 3). Clinical and histopathological features were consistent with morphea. Topical calcipotriol betamethasone combination ointment twice a day for psoriatic plaques, tacrolimus 0.1% ointment once a day and methotrexate 15 mg per week sc. for the morphea plaques and psoriatic plaques, and minoxidil 5% spray 5-puff twice a day for alopecia areata were administered to the patient after the diagnosis and she is under follow-up.
Morphea is commonly seen alone, whereas psoriasis is an immune-mediated disease that is most frequently...


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