A systematic review of morphea treatments and therapeutic algorithm

J Am Acad Dermatol. 2011 Nov;65(5):925-41. doi: 10.1016/j.jaad.2010.09.006. Epub 2011 Jun 8.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Algorithms
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Calcitriol / analogs & derivatives
  • Calcitriol / therapeutic use
  • Clinical Trials as Topic
  • Evidence-Based Medicine
  • Humans
  • Immunologic Factors / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Methotrexate / therapeutic use
  • PUVA Therapy
  • Scleroderma, Localized / drug therapy
  • Scleroderma, Localized / radiotherapy
  • Scleroderma, Localized / therapy*
  • Tacrolimus / therapeutic use
  • Treatment Outcome
  • Ultraviolet Therapy
  • Vitamin D / therapeutic use

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Immunologic Factors
  • Immunosuppressive Agents
  • Vitamin D
  • calcipotriene
  • Calcitriol
  • Tacrolimus
  • Methotrexate