PMC10064457_01
Medication timeline detailing the treatments, dosages, and responses since the initial presentation in July 2015.. The color of each bar corresponds to the patient's treatment response, with green indicating a good response, yellow indicating a limited or unsustained response, and red indicating a poor response.
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Since his initial presentation in July 2015 until November 2022, he received various anti-psoriatic therapies which included topicals (corticosteroids, calcipotriol, tazarotene), as well as systemic agents (cetirizine) and various biologics (ustekinumab, secukinumab, and ixekizumab), all of which produced minimal benefit apart from ustekinumab (Figure 1).
Clinical and histologic images of the patient's left calf. (a) Hard, lichenified, pearly plaques with violaceous edges beneath a plaque of psoriasis. (b) A more magnified image clearly illustrating the coexistence of erythematous well-demarcated plaques with a psoriasiform appearance and morpheaform plaques below. (c-e) Shave biopsy demonstrating upper dermal sclerosis with eosinophilic homogenization of the papillary dermis overlying a sparse inflammatory cell infiltrate. Focally within the dermis and extending to the base of the biopsy there is an interstitial and perivascular lymphocytic infiltrate with scattered plasma cells (hematoxylin and eosin, 10x, 25x, and 40x for (c), (d), and (e), respectively).
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In July 2022, he returned with several hard, waxy, white, thick plaques with violaceous edges on his left calf, which resembled morphea (Figure 2(a) and (b)). Histologic examination of a biopsy specimen from one of the lesions on his calf confirmed the diagnosis of morphea in association with lichen sclerosus on the superficial aspect of the lesion (Figure 2(c)-(e)).
Clinical image of several hard, waxy, white, thick plaques with significant scale and violaceous edges on the patient's lower back.
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His lower back revealed a similar clinical appearance but with more scale (Figure 3).