๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
DIFFERENTIAL DIAGNOSIS
In addition to the other morpheaform and sclerodermoid conditions discussed above, the most important entity in the differential diagnosis is SSc (see Ch. 43). Asymmetric skin involvement as well as the absence of Raynaud phenomenon and lung or esophageal involvement are characteristic features of morphea. The other common considerations are lichen sclerosus and keloids; however, the former can coexist with morphea. Dupuytren contracture and camptodactyly, a benign ulnar deviation of the fourth and fifth finger, can be clinically distinguished from linear morphea.
Scleredema leads to diffuse woody induration, primarily of the upper back and neck. Symmetric tightness and induration of acral skin can be seen in insulin-dependent diabetics with cheiroarthropathy, also referred to as waxy skin and stiff joints. In children, progeria and premature aging syndromes need to be distinguished from ParryโRomberg syndrome, but the latter is unilateral, as is silent sinus syndrome. Additional entities in the sclerodermoid differential diagnosis (e.g. scleromyxedema) are listed in Table 43.7.