Background Little is known about the health-related quality of life (HRQOL) of patients with morphea, and previous studies have yielded conflicting results. Objectives To determine the impact of morphea on HRQOL and clinical and demographic correlates of HRQOL in adults. Methods Cross sectional survey (n=73) of Morphea in Adults and Children (MAC) cohort. Results Morphea impairs HRQOL in adults. Patients were most impaired by emotional well-being and concerns that the disease will progress to their internal organs. Patients with morphea had worse skin-specific HRQOL than those with non-melanoma skin cancer, vitiligo, and alopecia (lowest P <.0001). Study subjects had significantly worse global HRQOL scores than the general U.S. population for all subscales (all P ≤.004) with the exception of bodily pain. Comorbidity (r =.35-.51, P ≤ .0029 -.0001) and symptoms of pruritus (r =.38 -.64, P ≤.001-.0001) and pain (r =.46-.74, P <.0001) were associated with impairment in multiple domains of skin-specific and global HRQOL. Physician-based measures of disease severity correlated with patient-reported HRQOL. Conclusion Patients with morphea have negative impact on HRQOL particularly if symptoms (pruritus and pain) or concerns regarding internal manifestations are present. Providers should be aware of this when evaluating and treating patients.

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Background The distinction between chondrodermatitis nodularis helicis (CNH) and hyperplastic actinic keratosis (HAK) on the ear can pose a diagnostic challenge. We aimed to identify histopathological characteristics that could distinguish between CNH and HAK on routine sections using penalized least absolute shrinkage and selection operator (LASSO) logistic regression analysis. Methods Cases of CNH (n = 80) and HAK (n = 28) were analyzed for selected histopathological characteristics. Fisher's exact test and LASSO regression were performed. Results In univariate analyses, the following were significantly associated with CNH: ulceration, acanthosis, granular layer in the majority of the lesion, hypergranulosis at the periphery of the lesion, hyperkeratosis at the periphery of the lesion, hyperparakeratosis at the periphery of the lesion, fibrosis, increased blood vessels, vertically oriented blood vessels, and fibrin. A LASSO model excluding atypia found that fibrin, fibrosis, presence of granular layer, ulceration, and vertically oriented blood vessels were most predictive of CNH. Keratinized strap cells were not a significant predictor. Conclusion We have identified features that may aid in differentiating these entities and demonstrated that a LASSO regression model can identify predictors that may improve diagnostic accuracy. Our results indicate that the highest diagnostic accuracy in this dilemma is dependent on obtaining biopsy specimens with visible dermis.

Sarcoidosis is a multisystem inflammatory condition of unknown etiology. Variability in the cutaneous features of sarcoidosis is profound, and its protean manifestations affirm the condition's designation as one of dermatology's "great mimics." Cutaneous phenotypes of sarcoidosis include but are by no means limited to ichthyosiform, alopecic, erythrodermic, angiolupoid, and verrucous variants. Verrucous sarcoidosis is an exceedingly rare manifestation, and previous reports of this phenotype are limited to 15 cases. Most cases in the extant literature presented on the extremities, with clinical features mimicking that of a common wart, or as verrucous crateriform nodules, ulcers, or cutaneous horns. Only 4 previous reports of facial verrucous sarcoidosis exist in the literature, and to our knowledge, no prior cases have demonstrated filiform lesion morphology. Here we present a case of filiform verrucous sarcoidosis in an otherwise healthy, middle-aged African American man, devoid of internal organ involvement and limited to the face, histopathologically confirmed by the presence of characteristic granulomata devoid of lymphocytic infiltrates.

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