S1C26P16-1: Although great emphasis is placed on changes at the interface between the reticular dermis and the subcutaneous fat in the diagnosis of morphea, some examples are associated with a superficial component. Just as in the deep component, but at the interface between the reticular dermis and the subcutis, the superficial component evolves as a spreading, sclerosing process; it spreads upward to transform the fibrous character of the papillary dermis and it spreads downward to alter the neighboring reticular dermis (substitutive collagenosis). At the deep limit of this downward spread, lymphocytes and histiocytes infiltrate among the altered collagen bundles (a lymphohistiocytic collagenosis that is morphea-like type). In the spread of the fibrosing process, as it involves the papillary dermis, the transformed matrix takes on some of the qualities of a lesion of lichen sclerosis et atrophicus. Generally, the matrix is more clearly fibrous than the transformed matrix of classic L S & A; it also tends to be less edematous. The differences are relative; it seems reasonable to classify LS&A as a form of superficial morphea, while admitting that there often are minor differences between isolated LS&A and a lesion of morphea with both superficial and deep components. The patterns in this field would be in keeping with a superficial component of a lesion of morphea (in this example, a deep component also was represented).

S1C26P16-2: A mild lymphohistiocytic collagenosis is represented in this field from a lesion of morphea. Collagen bundles in the area of the collagenosis vary in size. There is some evidence of “streaking of collagen bundles” (a pattern in which collagen bundles are straight, and are parallel to both their neighbors and to the surface of the skin). A ductal structure to the right (green arrows) is interpreted as a sweat duct with periductal sclerosis. The duct is well on the way to atrophy; it has lost the right of domain in the sclerotic dermis.

S1C26P16-3: In this area of a lesion of morphea, collagen bundles are coarsened. In its diameter, one is particularly prominent (green arrows). It is partially outlined by concentric sheaths of collagen bundles. This pattern might be characterized as “collagenous ring binding;” collagenous ring binding is an occasional feature of lesions of morphea.

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