Evaluation for extracutaneous complications of morphea in adults

Assess for the following:	Management:
Signs of deep musculoskeletal involvement (eg, muscle pain or tightness; deep/fixed lesions; decreased ROM, contractures, or limb length discrepancy)	Obtain MRI to assess for fascial or muscle involvement^*. Rheumatology referral for further assessment and comanagement. PT, OT, or orthopedics referral for patients with decreased ROM, contracture, or limb length discrepancy.
Signs or symptoms of autoimmune disease (eg, thyroid symptoms, arthritis, Raynaud phenomenon, nail fold capillary changes, characteristic rash)	Initiate appropriate evaluation for suspected disease. Routine testing for autoimmune diseases is not indicated in the absence of suggestive signs or symptoms.
Genital lichen sclerosus-like lesions (assess patients with generalized morphea)	Manage or arrange for referral for management of genital lichen sclerosus.
Craniofacial morphea lesions (eg, en coup de sabre, PFH)	Ophthalmology referral and periodic assessment for ocular symptoms. Oral and TMJ examination plus dentistry or oral and maxillofacial surgery referral if evidence of dental involvement or jaw dysfunction. MRI of facial soft tissue for patients with facial asymmetry. Urgent neurologic evaluation for seizures, focal neurologic deficits, severe migraines. Neurology referral for other neurologic symptoms (eg, headache, neuropsychiatric abnormalities). MRI may be appropriate based on clinical findings. Routine brain imaging is not indicated in the absence of symptoms.

MRI: magnetic resonance imaging; OT: occupational therapy; PFH: progressive facial hemiatrophy; PT: physical therapy; ROM: range of motion; TMJ: temporomandibular joint.

* Ultrasound is an alternative when MRI is not feasible.

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Evaluation for extracutaneous complications of morphea in adults

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