Morphea (localized scleroderma) in adults: Selection of initial treatment

UVA1: ultraviolet A1; UVB: ultraviolet B; UVA: ultraviolet A.
* Inactive morphea is unlikely to respond to immunomodulatory therapy or phototherapy. Interventions for inactive morphea are primarily focused on improvement of functional impairment and disfigurement as well as monitoring for recurrence of disease activity.
¶ Examples include facial involvement and tethered or deeply sclerotic lesions that overlie joints.
Δ The goal of multidisciplinary management is to maximize function and minimize further disability.
◊ The relative efficacy of these interventions is unclear. We primarily use topical corticosteroids. In our experience, lesions that exhibit associated epidermal changes (eg, lichen sclerosis-like features overlying indurated plaques) respond best to topical therapy.
§ Phototherapy options include UVA1, narrowband UVB, and broadband UVA. In general, when UVA1 phototherapy is available, we favor this modality. Due to less depth of penetration of UVB in comparison with UVA1 and broadband UVA, we usually reserve narrowband UVB for patients with lesions that are relatively superficial, exhibiting only mild induration.
¥ We reserve the addition of systemic glucocorticoids for patients with very inflammatory, rapidly progressive morphea (eg, evolution to involve multiple body sites or rapid extension of lesions over multiple joints within less than 6 months).
‡ Intralesional corticosteroid injections should be limited to patients with a small area of involvement in whom the depth of morphea does not extend beyond the subcutaneous tissue.