Morphea as Part of the Dermatological Manifestation of Celia
Celiac disease is an immune-mediated disease, affecting multiple systems and organs including several dermatological conditions. Morphea, or localized scleroderma, is also an immune-mediated condition, in which an association with celiac disease has not thus far been recognized. A 10-year-old girl was referred to a gastroenterology clinic due to positive celiac serology after having presented to her primary care physician with a few months of abdominal pain associated with nausea, vomiting, and occasional headache. In addition, she complained of painful white markings on her lower and middle back. She denied shortness of breath, color changes of her palms and feet, difficulty swallowing, or any other complaints. Physical examination demonstrated the aforementioned skin findings on her lower-mid back, where a tender whitish-ivory atrophic plaque approximately 10 × 3 cm, sensitive to touch was seen; there were no other pertinent findings.

Diagnostic laboratory results were as follows: anti-tissue transglutaminase immunoglobulin A (anti-tTG IgA) antibody titers were 49 U/mL and anti-endomysial antibodies titers above 1:5. Complete blood count, thyroid-stimulating hormone, and C-reactive protein were within normal range. The parents preferred the no-biopsy approach; therefore, gastroscopy and small bowel biopsy were not performed, and a GFD was initiated. A punch biopsy from the lesion was consistent with morphea. Further workup to rule out systemic involvement included a normal echocardiogram and negative rheumatoid serology, including rheumatoid factor, antinuclear antibodies, and anti-Scl-70 antibodies. Her anti-tTG levels normalized with a GFD.

She was treated topically with a combination ointment containing betamethasone and calcipotriol for 4 weeks with marked improvement in consistency of the lesions, whereupon she was switched to topical mometasone furoate ointment and later to an emollient.

The patient decided to stop all topical steroids on her own accord 2 months after her diagnosis and short of some mild pruritus remained asymptomatic. At the last follow-up 2 years into the diagnosis, the patient had been adherent to a GFD and remained with negative celiac serology. No major change nor spreading of the skin lesions was observed, and the pruritus resolved without any systemic or local medications.