Brief Answer:
Asymmetry may be due to parry romberg's syn; Rx options & timing of surgery

Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic

I have gone through your query and I have understood it.

In Parry Romberg Syndrome, one side of the face develops normally and the other side slowly deteriorates.
Parry Romberg Syndrome is frequently accompanied with patches of morphea.

On the other hand, linear morphea/ en coup de sabre may also be associated with facial asymmetry/ hemifacial atrophy.
In fact Parry Romberg Syndrome is frequently associated with linear morphea and is considered to be a deep form of linear morphea.

Therefore, differentiating the two, remains arbitrary as some patient initially begin with morphea/ linear morphea and later progress to hemifacial atrophy/ PRS.

-Can you upload a digital Image for my review?
-When did you first notice this condition?
-You have been on treatment for last 6 months. How has it helped?

It is usually said that any cosmetic intervention should be only after the disease has stopped progressing.
However, there is an alternative view, that transplanted tissue is not affected by the degenerative process and it is not necessary to wait till the degenerative process has stopped progressing.

Autologous fat transplantation is the method that is standard for treatment of asymmetry wherein patients own fat is transplanted into multiple subcutaneous and intramuscular tunnels for aesthetic improvement/ to make up for wasting/ atrophy.

Multiple staged fat grafting may be required to achieve desired results.

The timing of surgical intervention is generally agreed to be the best following exhaustion of the disease course.
Most surgeons recommend observing it over one or two years before proceeding with reconstruction.
This time period is usually enough to know whether the disease has stopped progressing or not.

Regards
Hope this helps!

---

Brief Answer:
Steroids benefit by controlling disease activity

Detailed Answer:
Hi.

I understand your concern for privacy. However, I want to assure you that Images and Identity of an Individual are never shared publicly on this forum.

The diagnosis of Parry Romberg's is clinical.
Tests like x-rays, CT scans/ MRI only substantiate clinical diagnosis by visualizing deeper structures like orbits, subcutaneous tissue, muscle and bones etc for extent of involvement.

Oral steroids do seem to benefit in parry romberg's syndrome just as they do in morphea, because as I mentioned earlier parry romberg's syndrome is part of the spectrum of morhea or a deeper form of morphea.

Oral steroids are in fact drugs of choice for progressive/ active morphea.

Hydroxychloroquin is steroid sparing and is mainly for cutaneous involvement. It does not alter deeper involvement. It is usually combined with oral steroids.

Steroids may be continued till disease is active Or till it becomes inactive/ burns out.
They can be given initially for a period of 4-6 months and then slowly tapered down to see whether the disease is still active or inactive.

Eosinophilia and raised ESR are markers of disease activity in morphea and can be monitored.

Regards

---