A systematic review of morphea treatments and therapeutic algorithm - 14/10/11

Doi : 10.1016/j.jaad.2010.09.006

Brittany A. Zwischenberger, MD ^a, Heidi T. Jacobe, MD, MSCS ^a,^b,^⁎
^a Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
^b Dermatology Section (Medical Services), Dallas Veterans Affairs Medical Center, Dallas, Texas

Reprint requests: Heidi T. Jacobe, MD, MSCS, Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9069.

Abstract

Background

Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care.

Objective

We sought to create an evidence-based therapeutic algorithm.

Methods

We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized.

Results

Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported.

Limitations

Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures.

Conclusion

Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making.

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Key words : localized scleroderma, therapeutics

Abbreviations used : BB, ECDS, IV, IVMP, MSS, MTX, NB, PCMT, PUVA, RCT, SCSS, SQ, US, UV

Plan

	Dr Jacobe’s work is supported by National Institutes of Health 5 K23 AR056303-02 and Career Real Estate Women Research Award. She has also received funding from the Dermatology Foundation in the form of a Career Development Award and Medical Dermatology Research Award.
	Conflicts of interest: None declared.