Localised Sclerosis M027

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-9-CM Codes: 701.0, 701.9
• ICD-10-AM Codes: L94.0, L94.1

Brief description

This is a skin disorder in which there are localised areas of hardened skin.

This condition can occur alone, or as part of the wider disease process of systemic sclerosis/scleroderma. In the latter case, the SOP for systemic sclerosis should be applied (see further comments, below). 

Confirming the diagnosis

The diagnosis can often be made based on the clinical findings, by a specialist dermatologist.  Biopsy and histology may be required in some cases. 

The relevant medical specialist is a dermatologist.

Additional diagnoses that are covered by SOP

• Circumscribed scleroderma
• Linear scleroderma
• Localised scleroderma
• Morphea

Conditions that are excluded from SOP

• Lipodermatosclerosis^#
• Systemic sclerosis*
• Systemic scleroderma* – systemic sclerosis SOP
• CREST syndrome* – systemic sclerosis SOP

* another SOP applies

^# non-SOP condition

Clinical onset

Onset can be at any age, but the mean age in adults is around 45 years.  Patients present with single or multiple skin plaques (raised patches) that are initially inflamed and then go on to become sclerotic (scarred) and then atrophic (wasted away).

Clinical worsening

This is a generally self-limiting condition that remains active typically for 3 to 6 years.  Residual skin scarring/atrophy is the end result.  Treatment may involve simply observation, topical medication or phototherapy.  Systemic treatment may be needed for more severe disease.  Such treatment may limit the spread of the disease and new lesion formation.

Comments

There may be circumstances where the veteran was correctly diagnosed with localised sclerosis and then, with the efflux of time and the development of further systemic manifestations, also correctly diagnosed as systemic sclerosis.  In this situation, the original diagnosis is no longer valid, having been replaced by the systemic sclerosis diagnosis.