Can Morphea Cause Fatigue?
Yes, morphea can cause fatigue. Morphea is a localized type of scleroderma which occurs due to excessive deposition of collagen in the deeper layers of the skin (dermis and/or subcutaneous tissue). The incidence of morphea is approximately 0.4-2.7 cases per 100,000 people in the United states. It’s seen in almost all races, but common in Whites and all forms of morphea are common in females. Morphea can be seen at any age, but more common from the age 2-14 years and in the mid 40’s.
The study “Physical Burden of Symptoms in Patients with Localized Scleroderma and Eosinophilic Fasciitis: done by Radboud University in Netherlands in 2008 was based on 74 patients with localized scleroderma. The study showed that fatigue was the commonest extracutaneous symptom seen in the study, 55% of the patients had fatigue. The next commonest symptoms were pain seen in 32% of patients and then itchiness seen in 22% of patients. Majority of the patients with morphea (94%) and eosinophilic fasciitis (75%) experienced fatigue. Pain and itchiness were more associated with eosinophilic fasciitis. Fatigue, pain and itchiness were experienced by 62% of patients in the study and fatigue was the commonest symptoms which were reported by patients.
Clinical Features Of Morphea
The clinical features of morphea varies with the sub type of morphea and according to the severity of the disease. Morphea is usually asymptomatic and skin lesion develop insidiously.
- Reddish, purplish circumscribed, oval skin patches seen mainly on the trunk (chest, stomach and back), sometimes seen in the face, arms, and legs.
- These skin lesions are firm and have a whitish area in the center of the lesion.
- The hair and sweat glands in the affected area disappears with time.
- The affected skin gradually becomes hard, thick and dry.
- According to the site and deepness of the skin lesions, morphea can be categorized as:
- Localized lesions – one or few skin lesions are limited to the trunk, arms and legs.
- Generalized lesions – the lesions are seen throughout the body, in almost all parts of the body.
- Linear lesions – linear lesions which are thick can be seen in the deeper layers of the skin (dermis) and these lesions are seen more in the head, upper body, arms, and legs. En Coup de Sabre is also falling into the linear subtype of morphea. There bandlike-sclerotic skin lesions with or without skin discoloration typically seen in the front and top of the head. This type manifest in one side of the head and does not go beyond the eyebrows.
- Morphea profunda or pan sclerotic lesions – these lesions involve the tissue underneath the skin (muscles and joints), therefore can cause serious muscle and joint problems.
Extracutaneous Manifestations Of Morphea
The extracutaneous manifestations are commonly seen in linear and generalized sub types of morphea. Cutaneous (skin) manifestations are the common manifestation of morphea and extracutaneous manifestations are seen in 20% of patients.
The most common extracutaneous manifestations are
- Fatigue
- Malaise
- Arthralgia – seen on the affected joint
- Arthritis
- Carpal tunnel syndrome
- Peripheral neuropathies
- Arthritis, carpal tunnel syndrome and peripheral neuropathies are seen in linear and deep types of morphea.
Rare manifestations are:
- Difficulty in swallowing
- Gastrointestinal reflux disease
- Shortness of breath
Neurologic symptoms are seen more in patients with En Coup de Sabre. The neurologic manifestations are seizures, headaches, progressive hemifacial atrophy, facial muscle weakness, cranial nerve palsies, eye pain and changes in the vision.
Systemic sclerosis features such as Raynaud phenomenon, sclerodactyly, telangiectasia and involvement of the internal organs are absent in morphea.
Conclusion
Yes, morphea can cause fatigue. Morphea is a localized type of scleroderma which occurs due to excessive deposition of collagen in the deeper layers of the skin (dermis and/or subcutaneous tissue). Cutaneous (skin) manifestations are the common manifestation of morphea and extracutaneous manifestations are seen in 20% of patients. Fatigue is the commonest extracutaneous manifestation. The study “Physical Burden of Symptoms in Patients with Localized Scleroderma and Eosinophilic Fasciitis: done by Radboud University in Netherlands in 2008 was based on 74 patients with localized scleroderma. The study showed that fatigue was the commonest extracutaneous symptom seen in the study, 55% of the patients had fatigue.
- Radboud University Medical Center, Netherlands. “Physical Burden of Symptoms in Patients with Localized Scleroderma and Eosinophilic Fasciitis” – https://pubmed.ncbi.nlm.nih.gov/18311881/
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