Superficial morphea of the lips and gingiva.

Morphea is a cutaneous disorder characterized by excessive collagen deposition. While in almost all cases the sclerosing process exclusively affects the skin, there are anecdotal cases in which associated mucosal involvement has been described. In 1999 McNiff et al. (1) described the first cases of superficial morphea, presenting as pigmented mucosal lesions with minimal cutaneous induration. Previously, it had been speculated that morphea might result from au-toimmunity, infection, drugs, etc (2). Recently, it has been suggested that morphea might be preceded by trauma and radiation (3,4). Most of the patients with oral morphea described in the literature suffered from scar-like or indurated whitish lesions of the oral mucosa, unerupted teeth, root development defects, root atrophy, localized gingival recession, and alveo-lar bone resorption (5). Furthermore, other orodental abnormalities such as widening of the periodontal space, temporomandibular disorders, and limited mouth opening have been reported in patients with scleroderma. To our knowledge, there are around 25 cases of morphea associated with oral and dental manifestations reported in the literature (5).It is still a matter of debate which treatment option is the most efficient (6). A 38-year-old female patient was referred to our Department due to the hypopigmented lesion extending from the lip to the base of the nose (Figure 1). Clinical examination revealed that the hypopigment-ed area also extended to the corresponding mucosal side of the lip and on the gingiva adjacent to tooth #22. The patient had a history of trauma (swinging blow) in that area 1.5 years ago. Three months before admittance to our Department she had tooth #22 extracted because of excessive mobility. The patient was concerned as the lesion slowly increased in size. The patient suffered from occasional minor gastric discomfort but was otherwise healthy. She had no history of radiation, autoimmune diseases, Raynaud's phenomenon, etc. Serum testings did not reveal thyroid abnormalities or pernicious anemia. C-reactive protein, glucose levels, liver enzymes, creatinine, lac-tate dehydrogenase, serum potassium, sodium, calcium , and phosphates were within normal ranges. As she mentioned a tick bite last year, she was sent for a Borrelia antibodies test which revealed no abnormalities. Human immunodeficiency virus (HIV), hepatitis B, C, and syphilis serology were negative. Histopathology of the mucosal lesion showed thickened, parakeratotic epithelium without significantly expressed papillomatosis together with intensely dense and hyalinized collagen in the underlying stroma as well as significant reduction of elastic fibers and their occasional spread into surrounding adipose tissue. …