Linear scleroderma in a child with diabetes
===========================================

* Rajiv Kuruppu Goonetilleke
* Shona Coutts
* Julie Edje

This report describes the case of a 12-year-old boy with type 1 diabetes mellitus who presented with an area of linear hyperpigmentation on his neck, and this later involved the left side of his face and forehead (figs 1–3). A diagnosis of morphoea was made. Morphoea, also known as localised scleroderma is relatively rare in children.1–3 It is more common than systemic scleroderma in children.

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.09.2008.0854/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/2009/bcr.09.2008.0854/F1)

Figure 1 
Lesions seen on forehead and chin.

![Figure 2](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.09.2008.0854/F2.medium.gif)

[Figure 2](http://casereports.bmj.com/content/2009/bcr.09.2008.0854/F2)

Figure 2 
Pigmentation on neck.

![Figure 3](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.09.2008.0854/F3.medium.gif)

[Figure 3](http://casereports.bmj.com/content/2009/bcr.09.2008.0854/F3)

Figure 3 
Linear scleroderma on forehead.

Morphoea is a connective tissue disorder characterised by hardening and thickening of the skin due to an increased collagen deposition. It is almost exclusively limited to the skin and subcutaneous tissues but can rarely involve underlying muscle and bone.

When linear scleroderma affects the head it is sometimes referred to as scleroderma en coup de sabre. It is a self-limiting condition which is thought to be autoimmune in origin. It can rarely affect underlying muscle and bone and when severe can progress over years causing significant cosmetic, structural and functional disability.

The patient was treated with methotrexate and then admitted for intravenous methylprednisolone.

After treatment with methylprednisolone his glycaemic control as expected became increasingly difficult. He needed intravenous insulin for a total of 34 h. His blood sugar control remained difficult for up to 3 months afterwards.

The patient’s HbA1c had increased from 6.7 to 7.5 at the follow-up clinic 3 months later.

This case highlights a condition which many paediatricians are not familiar with and illustrates the difficulties encountered in treating a patient with type 1 diabetes with methylprednisolone.

## Footnotes

*   **Competing interests:** none.

*   **Patient consent:** Patient/guardian consent was obtained for publication.

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