DEAR MAYO CLINIC: About six months ago, a large, white dent appeared on my left buttock. After a biopsy, I was diagnosed with morphea. I was told that it is not systemic, but that the drug methotrexate could prevent future skin lesions and possibly cure the morphea. Is this possible, and what are the risks of the treatment?
Morphea, which is a rare skin disorder, causes painless hardening and discoloration of the skin. In many cases, morphea affects only a few areas on the body. The condition usually goes away on its own within several years. In the meantime, treatment often can keep symptoms in check.
When morphea first develops, most people have just one or two lesions, usually on the abdomen, chest or back. The lesions tend to be round areas of whitened and hardened skin, sometimes surrounded by a faint lilac-colored border. Over time, the lesions fade away, but they may leave behind patches of discolored or darkened skin.
Depending on where it occurs, morphea may affect mobility, particularly if it forms on your arms or legs. In some cases, morphea may cause the affected skin to atrophy, leading to depressions in the skin.
The specific cause of morphea isn't known. It is thought to be a type of autoimmune disorder, in which the body's immune system mistakenly attacks healthy tissue, causing inflammation and leading to symptoms. Possible triggers for morphea may include radiation, skin trauma or a recent infection. Morphea itself is not an infectious disease, though, and it's not contagious.
Morphea affects only the skin; it doesn't involve other organs. When a health care provider suspects morphea, a blood test is done to rule out scleroderma, a related and more serious disorder. Scleroderma causes hardening of the skin, as well as hardening of the body's connective tissues, and can damage internal organs.
Although morphea eventually goes away on its own over time, treatment usually is recommended to decrease symptoms. Treatment works best when the condition is in its early stages, so the sooner a lesion is treated, the better.
The first step in treatment for morphea in a case like yours, where the condition is confined to one area, usually involves using a topical cream on the affected skin. The cream may include medications such as corticosteroids, calcineurin inhibitors or calcipotriene to reduce the inflammation that's causing symptoms.
When morphea is extensive, if it does not respond to topical treatment, or if it involves deeper tissue, then systemic treatment, such as methotrexate, may be the next step in treatment.
Methotrexate is a drug that suppresses the immune system. It's often prescribed in pill form for morphea, and it can reduce symptoms effectively. In dermatology, the medication typically is used in low doses. Because of that, more severe side effects, such as extensive hair loss, that may be associated with methotrexate in other situations are not usually a problem.
There are other treatment options for morphea beyond methotrexate, too. For example, phototherapy, which uses ultraviolet light, can improve the appearance of skin affected by morphea. A class of medications known as tetracyclines also can be helpful. If you're interested in an alternative to methotrexate to treat morphea, talk to your doctor about these and other treatment choices that may fit your situation. — Jason Sluzevich, M.D., Dermatology, Mayo Clinic, Jacksonville, Fla.