RT Book, Section A1 Mayeaux, E.J. A1 Raman, Vidya A2 Usatine, Richard P. A2 Sabella, Camille A2 Smith, Mindy Ann A2 Mayeaux, E.J. A2 Chumley, Heidi S. A2 Appachi, Elumalai SR Print(0) ID 1114878411 T1 Scleroderma and Morphea T2 The Color Atlas of Pediatrics YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 978-0-07-176701-9 LK accesspediatrics.mhmedical.com/content.aspx?aid=1114878411 RD 2024/03/29 AB A 4-year-old boy presented with a one-year history of skin redness and tightening over the right upper extremity. His mother had initially noticed the lesion after applying a temporary tattoo. He complained of occasional itching and pain over the area. His mother was concerned that his arm appeared to be “shrinking.” He had no prior medical problems or preceding infections and his immunizations were up-to-date. He had difficulty grasping a crayon due to involvement of his fingers. On exam, he had a large area of skin tightening extending from the right scapular region and upper arm down to the forearm, index finger and thumb (Figure 178-1). He was referred to a dermatologist who performed a punch biopsy confirming a diagnosis of morphea (localized scleroderma). He was treated with topical fluticasone without benefit and referred to a pediatric rheumatologist for systemic therapy with methotrexate. Serologic testing showed a negative ANA and scleroderma antibody and he has had no features of systemic scleroderma.