A systematic review of morphea treatments and therapeutic algorithm

Brittany A. Zwischenberger, Heidi T. Jacobe

Research output: Contribution to journalArticle

82 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)925-941
Number of pages17
JournalJournal of the American Academy of Dermatology
Volume65
Issue number5
DOIs
StatePublished - Nov 2011

Fingerprint

Localized Scleroderma
Tacrolimus
Methotrexate
Skin
Therapeutics
Adrenal Cortex Hormones
Search Engine
Publication Bias
Penicillamine
Phototherapy
Antimalarials
Interferon-gamma
Decision Making
Patient Care
Language
Outcome Assessment (Health Care)
Morbidity

Keywords

  • localized scleroderma
  • therapeutics

ASJC Scopus subject areas

  • Dermatology

Cite this

A systematic review of morphea treatments and therapeutic algorithm. / Zwischenberger, Brittany A.; Jacobe, Heidi T.

In: Journal of the American Academy of Dermatology, Vol. 65, No. 5, 11.2011, p. 925-941.

Research output: Contribution to journalArticle

@article{d1a18fe226724dc0bc928701d4addfef,
title = "A systematic review of morphea treatments and therapeutic algorithm",
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.",
keywords = "localized scleroderma, therapeutics",
author = "Zwischenberger, {Brittany A.} and Jacobe, {Heidi T.}",
year = "2011",
month = "11",
doi = "10.1016/j.jaad.2010.09.006",
language = "English (US)",
volume = "65",
pages = "925--941",
journal = "Journal of the American Academy of Dermatology",
issn = "0190-9622",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - A systematic review of morphea treatments and therapeutic algorithm

AU - Zwischenberger, Brittany A.

AU - Jacobe, Heidi T.

PY - 2011/11

Y1 - 2011/11

N2 - 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.

AB - 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.

KW - localized scleroderma

KW - therapeutics

UR - http://www.scopus.com/inward/record.url?scp=80054115914&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054115914&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2010.09.006

DO - 10.1016/j.jaad.2010.09.006

M3 - Article

C2 - 21645943

AN - SCOPUS:80054115914

VL - 65

SP - 925

EP - 941

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

SN - 0190-9622

IS - 5

ER -