Morphea is an uncommon, genetic skin condition marked with painless patches of hard and discolored skin. Morphea can affect the skin at varying intensity, which is most commonly seen in the trunk, extremities and sometimes on face too. It can also be found inside the mouth, eyes and the genitals. Depending on the amount of skin involved and depth of underlying tissue involvement, it can present itself as circumscribed or localized (few patches found on trunk and extremities), generalized (spread over a larger area on trunk and extremities), linear (lines involving the skin of the extremities or the head that can be spread to deeper layers), mixed (can be a combination of linear or generalized or linear or localized) and pansclerotic (involves all the skin along with deeper layers and on occasions bone too that may restrict joint movement). Morphea is basically localized type of scleroderma, which affects only the skin and related structures, but it may extend to the underlying muscle and bone.
Does Morphea Ever Go Away?
Morphea is a self-limiting condition and over time it slowly fades away without any kind of intervention. Each lesion might take on an average of 3-5 years to fade away.
However, after it resolves the skin discoloration still persists along with muscle weakness in very rare cases. Although, morphea goes away on its own, treatment is advised to limit the symptoms. Usually, treatment at earlier stages gives best results, so it is best to treat the lesion in its prime stage. Although, morphea can be managed with the above treatment options, there is no permanent cure for morphea in current literature.
The cause of morphea is still unknown. However, it is considered to be an abnormal immune response where the body’s immune system inadvertently attacks its own cells and tissues causing inflammation that lead to its classic symptomatology. There are various triggers leading to this condition, which may include periodic trauma to the skin, an infection or radiation therapy. Morphea is not an infection, nor is it contagious and spreads to other people.
The condition usually presents as an asymptomatic, waxing and waning disease, but on rare occasions there might be pain or pruritus. In the beginning, it starts as a purple or red area of skin discoloration that gradually turns white and thickens and hardens. With time this area thins out and contracts leaving the skin discolored giving it a scar like appearance, which may be an esthetic concern for some people. Depending on the site of occurrence, morphea may cause discrepancies in mobility, such as if linear morphea forms in limbs, affect the growth of the underlying bone, or if it intersects a joint, the thickening could limit the joint movement. Its primary occurrence is seen in childhood or early adulthood. Sometimes morphea may lead to atrophy of the skin, causing depression of the affected area.
Treatment For Morphea
Patients with morphea should be excluded from differential diagnosis of scleroderma or other serious disorders. Scleroderma is a related disorder in which along with the hardening of skin, there is hardening of the internal organs and the connective tissue too. Differences can be found based on the skin exam, skin biopsy and blood test.
The treatment of morphea depends on the severity of the condition at the time of presentation and it aims at avoiding the further spread of symptoms. Morphea with less than 3 months of present history can be most responsive to treatment. Morphea cases are monitored for changes along with application of topical medications (corticosteroids, calcipotriene or calcineurin inhibitors) or phototherapy. Treatment depends on the type of morphea. Localized or linear morphea is treated with topical ointments, while generalized morphea can be managed with phototherapy. Active deep morphea (pansclerotic) involving muscle and bone is managed with systemic treatment with oral steroids and/or methotrexate. Phototherapy is not preferred for deep morphea as UV light has poor penetrability for deeper tissues; hence, it might not be effective for such a condition.