A systematic review of morphea treatments and therapeutic algorithm.

Journal Article (Journal Article;Review;Systematic Review)

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.

Full Text

Duke Authors

Cited Authors

  • Zwischenberger, BA; Jacobe, HT

Published Date

  • November 2011

Published In

Volume / Issue

  • 65 / 5

Start / End Page

  • 925 - 941

PubMed ID

  • 21645943

Electronic International Standard Serial Number (EISSN)

  • 1097-6787

Digital Object Identifier (DOI)

  • 10.1016/j.jaad.2010.09.006


  • eng

Conference Location

  • United States