TY - JOUR
T1 - A systematic review of morphea treatments and therapeutic algorithm
AU - Zwischenberger, Brittany A.
AU - Jacobe, Heidi T.
N1 - Funding Information:
Dr Jacobe’s work is supported by National Institutes of Health 5 K23 AR056303-02 and Career Real Estate Women Research Award. She has also received funding from the Dermatology Foundation in the form of a Career Development Award and Medical Dermatology Research Award.
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
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U2 - 10.1016/j.jaad.2010.09.006
DO - 10.1016/j.jaad.2010.09.006
M3 - Article
C2 - 21645943
AN - SCOPUS:80054115914
SN - 0190-9622
VL - 65
SP - 925
EP - 941
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 5
ER -