Bullous localized scleroderma – presentation of two cases, therapeutic difficulties

Introduction. Localized scleroderma is an immunological, connective tissue disease. The main symptoms are atrophy and fibrosis of the connective tissue stroma, preceded by changes in the small blood vessels. Pathogenesis of morphea is still unknown. The possible role of genetic factors, immunological abnormalities, especially in cell-mediated immunity, trauma, viruses or infection with Borrelia burgdorferi is suspected. Several types of localized scleroderma can be distinguished: plaque morphea, generalized morphea, bullous morphea, linear morphea (scleroderma) and deep morphea.

Objective. To present two cases of bullous morphea and therapeutic difficulties connected with this disease.

Case report. Two cases of bullous morphea are presented in 70- and 84-year-old women. Each of them was treated with individually chosen therapy. Initially they were treated with crystalline penicillin, hydrocortisone, vascular drugs; and UVA phototherapy. Afterwards, the patients were treated with pulses of methylprednisolone and methotrexate. The treatment led to suppression of the disease – blisters healed and the indurations diminished.

Conclusions. The treatment of localized scleroderma is not satisfactory. It causes difficulties due to limited effectiveness of applied drugs and their side effects. It is crucial to start treatment as early as possible, when the pathological changes are in the initial stage.