Case Report 4 - Male Age 8 to age 27 progression
At age 8, patient developed a white line down the middle of his forehead. This occurred within about 2 weeks after being hit by a rock to that area. A consult jointly with a pediatrician and neurologist agreed that the pigment had been shocked and should eventually return, which it did.
At age 13, a pencil thin line appeared in this same location running vertically down center of forehead. Over the next 7 years this widened and lengthened reaching back to crown of skull and down to between eyes. Around age 17, a depression appeared in the jaw bone and chin area had reduced soft tissue, all on right side of face. Patient has loss of hair over affected areas on scalp and periodically experiences extreme pain in right jaw. Over the teenage years, consults were made with pediatrician, neurologist (CAT Scan included), dermatologist, and cosmetic surgeons, but no diagnosis.
At age 20, a diagnosis of en coup de sabre was made by a dermatologist and plaquenil was prescribed. The medicine was intolerable because of the stomach upset and a new dermatologist was enlisted. The new treatment was UVA photochemotherapy for a 6 month period which proved to help showing no disease progression by proof of photographs once a month.
At age 25, disease began progressing into right cheek. Patient began therapy of methotrexate and prednisone along with topical Dovonex. Now at age 27 and the disease seems to be in remission. Patient continues to use methotrexate. A tanning bed is used throughout the winter months to insure absorption of Vitamin D to the affected areas. He has also had several appointments with an Osteopath who uses cranial sacral massage and intravenous Vitamin C as a therapy to halt disease progression. Results at this time have been promising.
Patient adds that psychologically this is a very difficult disease to deal with especially during the teenage years. Stress seems to accelerate the disease along with physical changes through adolescence.