Generalized morphea presents as plaques four or more in number larger than 3 cm that become confluent and involve at least two out of seven anatomical sites (head, neck, right upper extremity, left upper extremity, right lower extremity, left lower extremity, anterior trunk and posterior trunk).
On the basis of widespread disease, absence of systemic involvement and suggestive histopathology, he was labelled as generalized morphea. After test dose, he was started on 7.5mg methotrexate weekly along with topical betamethasone valerate twice daily.
Generalized morphea is induration of skin starting as four or more individual plaques larger than 3 cm, that become confluent and involve at least two of the seven anatomical sites (head, neck, right upper extremity, left upper extremity, right lower extremity, left lower extremity, anterior trunk and posterior trunk).3,4 Within this group there are distinct clinical presentations which are: disseminated plaques morphea, pansclerotic morphea and eosinophilic fasciitis.
Arif and Hassan reported a case of generalized morphea associated with hypothyroidism.6
Generalized morphea is a rare condition and occurs in the cases of disseminated sclerosis without systemic involvement.3 It occurs mainly in adults and is diagnosed when four or more plaques become larger than 3cm and merge, involving two of the seven main anatomical areas (head and neck, left or right upper limb or lower limb, anterior or posterior trunk).4 Thyroid dysfunction is commonly reported in systemic sclerosis but it has been rarely associated with morphea.5,6 Moreover there are only few cases of plaque-type morphea reported to be associated with autoimmune thyroiditis.
Generalized morphea is a rare condition characterized by idiopathic sclerosis of the skin in a widespread distribution usually starting on the trunk and is not associated with systemic disturbances.
However, generalized morphea associated with hypothyroidism has not been reported to the best of our knowledge which makes our case a unique one.