Two Cases Of Morphea Complicated By Hashimoto’s Thyroiditis In Two Sisters And Literature Review

Background: Morphea also known as localized scleroderma, is a autoimmune disease which thickening or hardening in the dermal with subcutaneous fat loss。Its precise aetiology is uncertain,but there are evidences to suggest that it may be related to external factors, genetic, autoimmune and so on. Morphea not involving the internal organs, no Renault phenomena and the change of nailfold capillaries, but morphea can affect the subcutaneous fat, fascia, muscle and bone, the influence of joint activities or maimed, occur in the head and face can appear nervous system and eye complications. LS can be divided into five subtypes: circumscribed morphea,linear morphea, generalized morphea, pansclerotic morphea and mixed morphea.The relations between morphea and Lichen sclerosus et atrophicus are still controversial. Those two diseases share similar clinical and pathological features, both entities are chronic inflammatory skin diseases characterized by dermal fibrosis.Some scholars guess the two diseases are two different manifestations of the same disease spectrum. Diagnosis of morphea mainly based on history, clinical manifestations and histopathological examination. Early treatment of morphea is better, includes topical treatment system drugs, light therapy, physical therapy, and so on. Hashimoto ’s thyroiditis, also known as chronic lymphocytic thyroiditis, is the most common autoimmune thyroid disease. Both Morphea and Hashimoto are autoimmune diseases, related studies have shown that autoimmune diseases often interrelated. Patient with morphea have associated autoimmune disease includes:diabetes mellitus, Hashimoto thyroiditis, Graves disease, vitiligo, ulcerative colitis,psoriasis, and so on. Etiology of autoimmune diseases such as morphea and the correlation mechanism between them remains to be studied.Case presentation: Case 1: a 64-year-old female presented with skin rashes on the anterior neck, trunk and bilateral anterior shins for 5 years, itching skin rashes on the perineum for 4 years, and Hashimoto’s thyroiditis for 9 years. Physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema. Dermatological examination showed pink patches on the neck and breast,sclerosis and atrophy of skin over the back,porcelain-white patches on the perineum. Histopathological findings suggestedthe diagnosis of morphea on the breast and lichen sclerosus et atrophicus on the perineum.Case 2: a 55-year-old female, who was the younger sister of case 1, suffered from gradual sclerosis and atrophy Of skin in the left inframammary region and abdominal region for 4 years, as well as Hashimoto’s thyroiditis for 3 years. Physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema.Hypopigmentation, sclerosis, and atrophy of skin in the left inframammary region and abdominal region. Histopathological examination suggested a diagnosis of morphea.According to the clinical features,thyroid function tests, histopathology and AB-PAS staining, the 2 cases were both diagnosed as morphea complicated by Hashimoto’s thyroiditis.Conclusion: This is the first reported case about two sisters in a family suffering from morphea complicated by Hashimoto’s thyroiditis. Both morphea and Hashimoto’s thyroiditis are autoimmune diseases and have genetic predisposition. Autoimmune diseases in the same family, the same patient can erupt simultaneously at the same time,so when we make the clinical diagnosis of morphea, should pay attention to thyroid function tests and watch for the presence of other autoimmune diseases, as well as a family history of autoimmune diseases.