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Case Reports
.2023 Dec 27;15(12):e51202.
doi: 10.7759/cureus.51202. eCollection 2023 Dec.

Morphea Involving the Lips and Gingiva: A Rare Case Report

Affiliations
Case Reports

Morphea Involving the Lips and Gingiva: A Rare Case Report

Hamad Albagieh et al. Cureus..

Abstract

Morphea is a subtype of scleroderma that does not involve Raynaud's phenomenon or internal organ involvement. It is a connective tissue disease that features the excessive deposition of collagen in the dermis and subcutaneous tissue, leading to a thickening of the dermis and subcutaneous tissue, eventually forming a scar-like lesion. We represent a 19-year-old male Saudi patient displaying a white patch on the marginal gingiva of tooth #21 and multiple yellowish papules on the outer surface of the lip. Both teeth #21 and #22 have experienced recession and bone loss. The patient's clinical history and histopathology revealed characteristic features of localized scleroderma. A treatment was proposed involving immunosuppressants, methotrexate, and pimecrolimus cream along with topical corticosteroids and excimer laser therapy (308 nm). The patient followed the treatment plan for a full month and the white patch quickly improved for the patient. Afterward, the patient has been taking only methotrexate with a significant but gradual improvement. In this paper, we discuss the differential diagnosis to be considered and present an unusual occurrence of localized scleroderma in the oral cavity.

Keywords: en coup de sabre morphea; linear morphea; localized scleroderma; oral cavity lesion; oral pathology.

Copyright © 2023, Albagieh et al.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The extra-oral photograph shows a linear, white, pale, blanched appearance involving a central portion of the vermilion border of the upper lip below the philtrum
Figure 2
Figure 2. The intra-oral photograph shows a linear white patch involving the outer and inner surfaces of the upper lip, extending intra-orally into the marginal gingiva and obliteration of the mucolabial vestibule in relation to tooth #21
Figure 3
Figure 3. The intra-oral photograph shows that both teeth #21 and #22 experienced recession and bone loss, but it was more pronounced in tooth #21
Figure 4
Figure 4. Light microscopy of the biopsy specimens from the left labial mucosa
A. Mild hyperkeratotic parakeratinized stratified squamous epithelium with variable thickness in addition to fibrosis of the underlying connective tissue, (original magnification: 50x). B. Subepithelial hyalinization of hypocellular dense amorphous eosinophilic material (indicated by the black arrow) (original magnification: 100x). C. Presence of peri-vascular lymphocytic infiltrates (indicated by the blue arrows) (original magnification: 100x)
Figure 5
Figure 5. Extra-oral photograph showing a distinct improvement following treatment
Figure 6
Figure 6. Intra-oral photo showing persistent recession and bone loss on the involved teeth
Figure 7
Figure 7. CBCT view
a1. Corrected coronal image of tooth #21, a2. Corrected axial image of tooth #21, a3. Corrected sagittal image of tooth #21 b1. Corrected coronal image of tooth #22, b2. Corrected axial image of tooth #22, b3. Corrected sagittal image of tooth #22 CBCT: cone beam computed tomography
Figure 8
Figure 8. Panoramic radiograph and periapical radiograph of the upper anteriors
A. Periapical radiograph of the upper anteriors showing vertical bone loss on #21 and #22 and widening of the periodontal ligament space with loss of lamina dura; B. Panoramic radiograph taken on the same day showed sound dentition with no marginal alveolar bone loss detected on the first molars
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References

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