Abstract

Localized scleroderma (morphea) is a chronic inflammatory, immune-mediated disease. It is characterized by an area of fibrosis due to increased collagen production. En coup de sabre is a rare type of band-like scleroderma. The typical clinical finding is a linear lesion, often originating from one of the eyebrows and extending to the scalp, resembling a sword cut. Hair loss, skin dyschromia, and tissue atrophy may also be evident. There may be neurological and ophthalmological complications. Since this condition is more often seen in young patients and involves the visible face and scalp, linear scleroderma also benefits from aesthetic refinement, especially when standard therapy aims to stop disease progression rather than correct the cosmetic defect. We report a rare case of mixed morphea presenting with disseminated truncal plaques and a longstanding linear lesion en coup de sabre, successfully managed using a three-step aesthetic protocol combining radiofrequency microneedling, hyaluronic acid fillers, and botulinum toxin type A. No early or late adverse events occurred. Sustained clinical improvement in the tissue elasticity, volume restoration and facial symmetry was observed at 6 months follow-up. This case presents the role of minimally invasive aesthetic procedures as additional tools for structural improvement in stable morphea.

Keywords

Morphea, en coup de sabre, microneedling, filler, botulinum toxin, fibrosis