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Morphea and Pitiryiasis Rosea

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#1 Sunniersideup

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Posted 10 May 2013 - 08:06 PM

Hello! I am 28 years old and new to the forum. About three months ago I started to get a flat, circular, flaky rash that my GP diagnosed as ringworm. Around this same time, scar tissue started to form on the back of my neck, right over C7. The creams and oral anti-fungals for the rash didn't help, and the scar tissue continued to grow and change to a whitish color with a red ring around it. After an ultrasound to rule out a muscle tear on my neck ( I also was having neck stiffness), my GP couldn't find any muscular involvement and sent me to a dermatologist. The dermatologist did two biopsies on this past Tuesday and called me Thursday to tell me the scar-like spot came back as morphea and the rash that was treated as ringworm (I now have over a hundred lesions on my trunk) is pitiryiasis rosea.

She called in two separate creams for each and told me to come back in four weeks. I was also told that the morphea wasn't much to be concerned about.

When I was 15 I acquired Raynaud's off and on for a week and then it went away. It appeared again, just on the fingertips once since then. I have some joint pain in my wrists but no swelling. I am a massage therapist and just think its repetitive use? My mother has Systemic Lupus so I often wondered if the Raynaud's could be linked to that, however it hasn't happened very often.

So my questions are, should I still be tested for Systemic Scleroderma even though the biopsy came back as Morphea? Is Morphea really nothing to be too worried about? Can my dermatologist do a blood test to make sure? Does pitiryiasis rosea usually happen at the same time as morphea?

I'm sorry to have so many questions. I'm just a tad confused, and wondering if I should be more proactive than just putting a cream on, or if I just need to chill out because it's only one morphea spot and a rash.

Thank you to anyone who has any input.

Chris



#2 Shelley Ensz

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Posted 10 May 2013 - 09:00 PM

Hi Chris,

 

Welcome to Sclero Forums!  I'm sorry you have morphea and pitiryiasis rosea,

 

As it happens, this is the first I've ever heard of pitrylasis rosea. But, bear in mind that I am not a doctor, and I have no medical training at all. I have also not heard about it having any relationship with morphea or any type of scleroderma.  But we are always open to new topics, so if you do find any scientific abstracts relating the two, will you please let us know?

 

Morphea is distinctly different from systemic scleroderma, especially in its appearance. Systemic scleroderma does not occur in colored plaques, scattered about the body. Rather, its skin changes are colorless and are preceded by distinct phases of swelling and induration, or tethering to the underlying tissues.

 

Systemic scleroderma typically begins in the hands, feet or face and on both sides of the body at the same time. Only very rarely, 0 to 4% of the time, depending on the study, does morphea occur in overlap with systemic scleroderma.

 

The people with morphea most at risk for that occurring usually have anti-centromere antibodies, although the presence of anti-centromere does not automatically guarantee that systemic scleroderma will develop, and the antibodies can also occur in other diseases.  This also means that you have a 96 to 100% chance of never developing systemic scleroderma, but because scleroderma is so very rare to begin with, this risk level is still a tad higher than that of a person without morphea. See Types of Scleroderma.

 

I can guarantee that you will hear of exceptions to all of these rules, such as our dear Amanda, who clearly has both unmistakable morphea and systemic but without any antibodies. But at least you heard about such exceptions from us, right along with the actual statistics that should help to put your risk factors in better perspective.  It is *not* that there is some sort of "progression" of morphea that naturally takes place.  Localized (such as morphea) and systemic forms of scleroderma are considered to be very different disease processes and some doctors feel strongly that localized and systemic scleroderma should not even share the same "scleroderma" name.

 

Also, if you really want to worry -- which I'm very sure you don't, but many other newbies to this thread might be so inclined -- you should aim your worry at the more common ailments that any of us are more susceptible to, such as heart disease, diabetes, and cancer, for they are probably more likely to nab any of us, in the end, with or without any form of scleroderma.

 

Raynaud's is very common in the general population.  It is common for relatives of people with autoimmune diseases (such as lupus) to carry antibodies, without developing full blown disease, and also to have one or two symptoms of any other autoimmune disease. Also, 25% of people with morphea will experience one or two symptoms outside of "just" the skin involvement, such as Raynaud's, for example.

 

I'd venture to guess that you have probably sprouted your autoimmune disease (morphea), and your extra symptom due either to your mom's lupus or associated with your own morphea (Raynaud's).  If your Raynaud's remains in remission, you really don't have anything to worry about since it wouldn't be necessary to treat it, anyway.

 

Your best bet would be to let your primary care doctor know your medical history.  You might want to consider the merits of the approach of actively discouraging them from running antibody tests unless you have more pressing symptoms at some point that need to be addressed and if you are very well-insured for life and health insurance, because you are very likely to come up positive with some antibodies -- due to morphea and your family history of lupus --  and those antibodies could be very misleading.  Besides, systemic scleroderma is diagnosed based only on clinical symptoms and not on blood tests since blood tests can be both false positive and false negative.

 

I can understand that the usual approach might be to panic and run out and have a whole battery of tests right away, including the antibodies. But you are in a fairly unusual situation, at high risk for meaningless antibodies that could act against you in a legal fashion (making you uninsurable) while probably doing nothing at all to actually define any disease process, because you'd still have to wait for symptoms to develop anyway before even getting any worthwhile diagnosis or treatment.

 

It's food for thought, at least. And no matter what approach you end up deciding upon, we're here to provide you support all along the way.

 

:emoticons-group-hug:


Warm Hugs,

Shelley Ensz
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#3 Joelf

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Posted 10 May 2013 - 10:08 PM

Hi Chris,

 

Welcome to these forums!

 

I'm sorry to hear that you have morphea and pitiryiasis rosea; like Shelley, I've never heard of the latter.

 

I'm afraid that I can't add much to Shelley's helpful and informative post and as she's advised, Morphea and Systemic Scleroderma are two separate diseases and it is very rare to have both Systemic and Morphea (although Amanda is the exception that proves the rule!! )

 

However, I can send you a warm welcome to our community and let you know that you will receive a wealth of help and friendship from our members. Do please keep posting and let us know how you're faring.

 

Kind regards,


Jo Frowde
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#4 Sunniersideup

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Posted 11 May 2013 - 01:30 PM

Wow! I definitely appreciate the informative response!

I had actually never heard of pityriasis rosea either, and from what I have researched, not a lot is known about it. However, besides having many red splotches on my trunk, its painless and not too much trouble so Im not too worried.

I appreciate the advice on maybe discouraging any antibody tests unless any symptoms are pressing. I have heard before that I could show some symptoms, such as Raynaud's, because of my mother's lupus, without fully ever developing the disease.
I definitely do not want any trouble, insurance wise, in the future if I can help it!

My mind has definitely been somewhat put at ease! Thank you very much indeed.