Clinical and Experimental Dermatology
Subcutaneous immunoglobulin for the treatment of deep morphoea
in a child
M. A. Yamazaki-Nakashimada,
M. T. Garc
Clinical Immunology and
Dermatology, Instituto Nacional Pediatr
ıa, Mexico City, Mexico
Morphoea, also known as localized scleroderma, is a disorder characterized by exces-
sive collagen deposition leading to thickening of the dermis and/or subcutaneous tis-
sues. Intravenous IgG therapy has induced improvement in some ﬁbrotic conditions.
The primary indication for subcutaneous IgG (SCIG) is in primary immunodeﬁciency
disorders as replacement therapy; however, recently there has been considerable
interest in SCIG as an immunomodulatory agent. We report an 11-year-old girl with
deep morphoea who was successfully treated with SCIG.
Morphoea (localized scleroderma) is a disorder charac-
terized by excessive collagen deposition leading to
thickening of the dermis, subcutaneous tissues, or
both. The management of morphoea is still unsatisfac-
tory, and there have been very few randomized
controlled clinical trials.
Intravenous immunoglobulin (IVIG) has been used
in ﬁbrotic conditions, resulting in improvement.
The main indication for subcutaneous IgG (SCIG) is as
replacement immunoglobulin therapy in primary
immunodeﬁciency disorders (PIDD).
has been considerable interest in SCIG as an
immunomodulatory agent for inﬂammatory neuro-
We report a patient with mor-
phoea who responded to treatment with SCIG.
An 11-year-old girl presented with a 7-year history of
three plaques. She had been diagnosed with morphoea
and treated with topical corticosteroids and calcipotriol
for 2 months with improvement in the ﬁrst two
lesions but rapid progression of the third lesion on her
On physical examination, three indurated, sclerotic
plaques were seen on the patient’s body. Two were
superﬁcial sclerotic plaques (one lumbosacral and the
other on the right buttock), while the third was a
deep, ill-deﬁned, indurated plaque 100 9 70 mm on
the posterior right thigh (Fig. 1).
Because of the lack of response of the deep plaque
to topical treatments, and as systemic treatment was
not indicated, a therapeutic trial with SCIG was con-
sidered. Informed written consent was obtained from
the child’s parents.
A skin biopsy was taken before and after treatment
(Fig. 2). The ﬁrst biopsy was taken from the centre of the
lesion, and showed orthokeratosis and mild epidermal
atrophy, irregular collagen disposition with increased
density, fragmented appearance and adnexal embedding,
and a sparse lymphocytic perivascular inﬁltrate.
SCIG (Subglobin 16%; Octapharma Laboratories,
Mexico City, Mexico) 1.6 g (10 mL) twice weekly was
administered subcutaneously into the lesion on the
right thigh, to a total dose of 28.8 g within 2 months.
SCIG was initially administered using the push method,
but because of the difﬁculty in administering the medi-
cation to the indurated skin, a portable pump was pre-
ferred, as it offered easier administration and better
tolerance. The patient’s condition gradually improved
clinically in terms of induration and size of the lesion
according to a visual analogue scale (Fig. 1).
Correspondence: Dr Marco Antonio Yamazaki-Nakashimada, Department
of Clinical Immunology, Instituto Nacional de Pediatr
ıa, Insurgentes Sur
3700-C C. P. 04530, Col. Insurgentes Cuicuilco, Mexico City, Mexico
Conﬂict of interest: MAY-N has received lecture fees from Octapharma,
CSL Behring and Baxalta. The other authors declare that they have no
conﬂicts of interest.
Accepted for publication 20 May 2017
Clinical and Experimental Dermatology (2018) 43, pp303–305
ª 2017 British Association of Dermatologists