Morphea is a relatively uncommon disease that affects the skin and connective tissue with excessive collagen formation leading to hard and tight skin. It is a disease that is seen in equal proportion in both adults and children, but women have a higher predilection than men. Although, the etiology of morphea still remains unclear, largely it is considered an autoimmune disorder with genetic predisposition, in addition to possible trauma, infection or irradiation triggers.
What Is The Best Medicine For Morphea?
There is no one best medicine for morphea and the treatment is highly individualized. The treatment should be started with topical medicines, but in rapidly progressive cases, topical medicines are not sufficient, so it mandates system therapy, such as systemic corticosteroid and methotrexate as first line therapy.
Circumscribed or localized morphea have a less severe course and subside spontaneously over a period of 3-5 years. This lesion can be managed with less aggressive treatment modality, including topical therapy or phototherapy limited to the lesion. The lesions are more responsive to treatment when they are in their active form (< 3 months of initiation). Topical or intralesional corticosteroids have been found helpful in reducing inflammation and limit progression of the condition. Topical tracrolimus 0.1% and imiquimod 5% have also been used with limited success, in addition to topical occlusion calcipotriene, a vitamin D derivative. Studies have found superior results with the combination of topical steroids or calcipotriene along with phototherapy than either of the treatment methods alone.
Phototherapy involves the exposure of the lesion to UVA1, PUVA and UVB broadband of wavelengths, which have yielded very good results. UVA1 penetrates the dermal layer to the subcutis, so it can be used as low dose, medium dose and high dose depending on the severity and depth of the lesion. PUVA is psoralen UVA, which is the combining usage of UVA1 phototherapy along with a chemical substance, psoralen that enhances the skin sensitivity to UVA radiation.
Generalized, pansclerotic and linear subtypes of morphea need an aggressive treatment modality, especially depending on the extent of involvement of the deeper layers. More the involvement of deeper layers, more aggressive should be the treatment. There have been reported cases of success with the combination therapy of systemic corticosteroid, either monthly pulsed IV methylprednisolone or oral prednisone and weekly methotrexate. This combination can be used in severe or rapidly progressive form of morphea. Relapse is also common in the disease form, so to avoid that methotrexate treatment is recommended for at least 2 years. Methotrexate resistant lesions should be treated with mycophenolate mofetil.
Although, systemic corticosteroids have been found helpful for treatment of active phase of morphea, they are of little help when the condition is more established. They are also not recommended for long term therapy due to their potential side effects and tendency for relapse when discontinued.
Extracorporeal photopheresis has shown promising results in the treatment of generalized deep morphea. Photodynamic therapy using topical 5-aminolevulinic acid, bosentan (for refractory ulcerations in panscerotic morphea) and abatacept have been found helpful for treating deep morphea.
Symptoms Of Morphea
The clinical presentation of morphea or localized scleroderma is diverse depending on the subdivision of the disease, localization of the condition and the depth of involvement. Broadly it can be classified as circumscribed, linear, generalized, pansclerotic and mixed. The disease process includes the involvement of the skin in circumscribed subtype localized to one to three lesions, while in generalized subtype spread over a wider area of the skin, linear subtype involves a linear streak in the skin or involving the deeper tissue and sometimes bone too. Pansclerotic subtype involves the skin, fascia, muscles and bone too. Mixed lesions include one or more subtype occurring in an individual at the same time. Since, morphea has a potential to run a severe course, especially in linear and pansclerotic types, it is important to initiate a suitable treatment promptly to avoid morbidity and deformity of the joints causing permanent disability.
Also Read:
