“Deep morphea as an Unusual Cause of Body Asymmetry”

Abstract

Deep morphea is a rare variant of localized scleroderma characterized by cutaneous induration and involvement of deeper soft tissues, whose progression may ultimately result in functional impairment. We report the case of a 43-year-old woman with a 21-year history of disease, marked by progressive atrophy, rigidity, and restriction of range of motion, in the absence of systemic manifestations. Physical examination revealed notable body asymmetry and residual cutaneous changes affecting the right hemiabdomen and the left lower extremity. Histopathological analysis demonstrated fibrosis of the dermis and subcutaneous tissue, reduced cellularity, and collagen thickening, findings consistent with a chronic inactive stage. Additional laboratory studies showed normal inflammatory markers and negative autoantibody testing. Given the patient’s limited tolerance to immunosuppressive therapy, a conservative management approach with physical therapy was pursued. This case underscores the slowly progressive yet primarily localized nature of deep morphea and highlights the importance of a multidisciplinary strategy to optimize long-term functional outcomes.