What is morphea?
Morphea (syn.: localized scleroderma) is a patchy, chronic inflammation of the dermis where the elastic connective tissue of the skin is affected. This causes the skin to stiffen and typically turn brown, sometimes with a white sheen due to scarring.
Usually, there are one or several sharply defined reddish-brown to pale brown patches, often on the trunk or legs. On the face, a specific form appears, forming a stripe over the forehead (coup de sabre). In this form, the underlying fat tissue may also be affected, leading to fat loss and the formation of a depression. In rare cases, even the bone beneath the patch may be affected.
morphea ‘en coup de sabre’
What is the cause?
The cause is unknown. In morphea, the connective tissue of the dermis is damaged, causing the affected skin to lose its elasticity, stiffen, harden, and sometimes darken.
How is it treated?
The cause is unknown, and current treatments can alleviate symptoms but not completely cure the condition. Treatment usually begins with strong corticosteroid creams, which can make the skin more supple, although the brown discoloration often persists. Light therapy, preferably PUVA (psoralen pills + ultraviolet A light therapy), may also be used, as UVA penetrates deeper into the skin than UVB light therapy. For extensive patches, treatment with methotrexate (tablets or injections) is an option.
In chronic inactive patches, only residual discoloration remains, and further therapy is not beneficial.
What is the prognosis?
Many people with localized scleroderma fear that it will progress to systemic scleroderma, but this is a completely different and much more severe disease. Morphea does not progress to systemic scleroderma. It usually remains limited to one or a few patches. In rare cases, larger areas of skin are affected. After treatment, only residual brown discoloration of the skin typically remains.
