Morphea (localized scleroderma)

Morphea is a fibrosing disorder of the skin without systemic involvement. It can be clinically classified in different forms: circumscribed, linear, generalized, pansclerotic and mixed forms. The pathogenesis is not completely understood. An underlying predisposition and environmental factors are required to develop the disease. No causal treatment for morphea exists. Topical systemic and phototherapy are used. Topical treatments are adequate for limited forms, while phototherapy and systemic treatment are used for the more severe forms of the disease. Corticosteroids are the mainstay of topical treatments. Topical calcipotriol and tacrolimus have been evaluated in open studies and they seem to improve significantly morphea. UVA1 which penetrate deeper in the dermis than narrow-band UVB are usually considered the best option in phototherapy. Methotrexate is the systemic drug which has the best evidences; it can be used in addition to corticosteroids, in particular in severe morphea of young people.