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Dermatology (Expert Forum)
What's next
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
Welcome to the DERMATOLOGY FORUM! Questions in this forum are answered by Dermatologists from St. Luke's Roosevelt Hospital, under the direction of Andrew Alexis, M.D., M.P.H.
What's next
by paranoid?, May 08, 2004 12:00AM
Hi Dr.
It's me again. I really appreciate your help. But I received the referral to a rheumologist from my dermatologist and I would like to write what she wrote and hope you can assist me it what to expect next (I posted before several times re: morphea, two rashes, upper right arm and left buttock).
Physical finding: A. Mohled (??? cant understand writing) hyperpigmentation on the right lateral arm. B. An area of non tender violaceous discoloration on left hip.
Pertinent labs: Both bioposis have increased dermal collagen and lowgrade inflammantion suggestive of morphea. Please evaluate for underlying systemic pss.
Impression: increased dermal collagen in specimans A&B c/w morphea.
Speciman A. Interpretation Orthokeratosis and mild atrophy of the epidermis and low power examination increaased dermal collagnis sen throughout. There is perifollicular inflammantion and fibrosis around the hair follicles.
Speciman B. Orthokeratosis and epeidermal atrophy. low grade perivascular inflammantion is seen in the dermis. Increased dermal collagenis noted again.
In 2001, I fractured my left knee. Which bothers me sometimes. Last year of so my same knee was bothering me and my left foot was tingling. I went to my ortho and he said it was caused from a nerve. He injected me with a shot and it went away. But know it came back. Can this all be related to the systemic scleroderma. Remember all my other blood work came back negative. What is the rheumologist going to do. This has me soo worried.
I appreciate your time.
It's me again. I really appreciate your help. But I received the referral to a rheumologist from my dermatologist and I would like to write what she wrote and hope you can assist me it what to expect next (I posted before several times re: morphea, two rashes, upper right arm and left buttock).
Physical finding: A. Mohled (??? cant understand writing) hyperpigmentation on the right lateral arm. B. An area of non tender violaceous discoloration on left hip.
Pertinent labs: Both bioposis have increased dermal collagen and lowgrade inflammantion suggestive of morphea. Please evaluate for underlying systemic pss.
Impression: increased dermal collagen in specimans A&B c/w morphea.
Speciman A. Interpretation Orthokeratosis and mild atrophy of the epidermis and low power examination increaased dermal collagnis sen throughout. There is perifollicular inflammantion and fibrosis around the hair follicles.
Speciman B. Orthokeratosis and epeidermal atrophy. low grade perivascular inflammantion is seen in the dermis. Increased dermal collagenis noted again.
In 2001, I fractured my left knee. Which bothers me sometimes. Last year of so my same knee was bothering me and my left foot was tingling. I went to my ortho and he said it was caused from a nerve. He injected me with a shot and it went away. But know it came back. Can this all be related to the systemic scleroderma. Remember all my other blood work came back negative. What is the rheumologist going to do. This has me soo worried.
I appreciate your time.
Doctor's Answer
by Alan Rockoff, MD, May 09, 2004 12:00AM
, May 09, 2004 12:00AM
The rheumatologist will examine you, look at the lab data, and tell you that you have morphea, not scleroderma. The clinical description of both spots sounds exactly like morphea. The pathology is consistent with it--the pathologist added, "Please evaluate for underlying systemic pss." because they can't tell from the biopsy whether the little piece of skin they have is part of a whole-body involvement ("pss" equals "progressive systemic sclerosis" which is official name of scleroderma.) However, you have 2 isolated patches and your blood work is negative. So I think you have morphea only, and that's what the rheumatologist is going to tell you.
Take care.
Dr. Rockoff
Take care.
Dr. Rockoff
