Adult-onset bilateral Parry-Romberg syndrome

Parry-Romberg Syndrome (PRS), or progressive hemifacial atrophy, is an uncommon disorder characterized by progressive unilateral loss of adipose tissue and underlying structures including muscle, cartilage, and bone, often with little or no sclerosis. PRS and morphea en coup de sabre (ECDS) have significant overlap, often coexist, and are likely different phenotypes of morphea.1 PRS usually presents in the first decade of life, but later presentations have been described.1 It is more common in females and the pathogenesis is not completely understood.1 Neurologic symptoms are the most common extracutaneous systemic manifestation. Bilateral disease occurs in rare instances.1 We describe a woman with profound bilateral facial atrophy whose presentation does not follow the typically reported disease course or histopathologic findings seen in PRS