International Journal of Dermatology, Vol. 35, No. 12, December 1996

MORPHOLOGY

DOUBLE-LINED LINEAR SCLERODERMA

HIDEYUKI TABATA, M.D.,

AKIO YAMAKAGE, M.D., AND SOJI YAMAZAKI, M.D.

A 22-year-old Japanese woman presented with two parallelband-like pigmented atroptiic lesions on her left forehead(Fig, 1). She had had a traffic accident and hit her foreheadforcefully when she was 11 years old. The skin depressionsoccurred about a year later and the skin lesions slowly in-creased in size. Both atrophic bands developed ainnost simul-taneously. She had no sclerodactyly and no Raynaud'sphenomenon. We suspected linear scleroderma or partiallipoatrophy. There were no abnormal laboratory findings.Antinuclear antibody was within the normal range (20x). Achest x-ray showed no pulmonary fibrosis. No abnormalitywas found in her brain computerized tomogram. A skin biopsyrevealed a slight swelling of collagen fibers in the dermis.Lymphocytic infiltrations were seen mainly around the der-mal vessels. No atrophy of fatty tissue was found (Fig. 2).With these clinical and histologic findings, although the latterwere not typical of scleroderma, a diagnosis of linear sclero-derma was made. Treatment involved topical steroids andthe antiallergic drug, tranilast.' Within 6 months, the pigmen-tation of the lesions had decreased.

Figure 1. Two band-like pigmented grooves on the leftforehead; a lilac-colored ring was not found.

From the Department of Dermatology, Dokkyo UniversitySchool of Medicine, Mibu, Tochigi, Japan.

Address for correspondence: Hideyuki Tabata, M.D., Depart-ment of Dermatology, Dokkyo University School of Medicine,880 Kita-kobayashi, Mibu, Tochigi 321-02, Japan.

Figure 2. Swelling of collagen fibers in the dermis andpcrivascular lymphocytic infiltration, (hematoxylin andeosin, original magnification x 50)

DISCUSSION

Localized scleroderma, including the linear type, is arelatively uncommon disorder, and consists usually of asingle band. In this case, parallel pigmented grooveswere found on the frontoparietal area of the head. Clin-ically, this seems to be a very rare case. The cause oflinear scleroderma is not known; however, in the past,trauma,^ irradiation,-' BCG vaccination,'' and anomaliesof the vertebral column^'^ have been reported to be pro-vocative factors. In our case, the skin lesions occurred 1year after a traffic accident. We suspected that micro-circulatory disturbances or necrologic damage may in-duce this disease. There is no danger of progression tosystemic scleroderma.

REFERENCES

1. Taniguchi S, Yorifuji T, Hamada T. Treatment of linearlocalized scleroderma with the anti-allergic drug, trani-last. Clin Exp Dermatol 1994; 19:391-393.

2. Christianson HB, Dorsey CS, O'Leary PA, et al. Local-ized scleroderma. A clinical study of two hundred thirty-five cases. Arch Dermatol 1956; 74:629-639.

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