What's on this Page
Which treatment options can be considered in patients with morphea?
Not all patients with morphea require pharmacologic intervention. It is important to first assess whether lesions are active (often present <3 months with signs of inflammation on exam), as these are most responsive to therapy. Chronic lesions may not require medications but may benefit from referrals to physical therapy and/or occupational therapy (if contractures or other functional impairments are present) or plastic surgery (for injection of fillers, autologous fat transfers, or other restorative procedures). Patients are commonly under the care of a dermatologist, but a rheumatologist may be asked to co-manage when systemic therapies are considered.
Topical therapies, intralesional steroids, and phototherapy can be used as initial treatment in patients with disease that does not extend beyond the dermis. Oral prednisone can be used in patients with generalized and deep forms of morphea as well as those with linear disease (especially if concern for potential contracture or growth limitation) or circumscribed forms that progress despite topical approaches. Methotrexate and mycophenolate mofetil have the best data among immunosuppressive medications and are often used as steroid-sparing agents in patients on prednisone. Additional medications such as infliximab, hydroxychloroquine, penicillamine, and cyclosporine have been described in the treatment of morphea but with less supporting data.
Common Treatment Options for Morphea
| Subtype of Morphea | Topical Therapy- Corticosteroids- Calcineurin inhibitors- Calcipotriene | Intralesional Steroids | Phototherapy | Systemic Meds- Methotrexate- Mycophenolate mofetil |
| Circumscribed | X | X | X | X + |
| Linear | X | X | X | X + |
| Generalized | X | X | ||
| Deep | X ++ | X |
+ : Commonly reserved for disease that is unresponsive to topical therapy, that extends beyond the dermis, or that carries risk of functional impairment.
++ : Lesions that are deep but localized may be treated with intralesional steroids.
