A systematic review of morphea treatments and therapeutic algorithm

• Published in: Journal of the American Academy of Dermatology 2011-11, Vol.65 (5), p.925-941
• Main Authors: Zwischenberger, Brittany A., MD, Jacobe, Heidi T., MD, MSCS
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Algorithms; Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Calcitriol - analogs & derivatives; Calcitriol - therapeutic use; Clinical Trials as Topic; Dermatology; Evidence-Based Medicine; Humans; Immunologic Factors - therapeutic use; Immunosuppressive Agents - therapeutic use; localized scleroderma; Medical sciences; Methotrexate - therapeutic use; PUVA Therapy; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scleroderma, Localized - drug therapy; Scleroderma, Localized - radiotherapy; Scleroderma, Localized - therapy; Tacrolimus - therapeutic use; therapeutics; Treatment Outcome; Ultraviolet Therapy; Vitamin D - therapeutic use
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2010.09.006

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.