Localised scleroderma treatments

There are different types of localised scleroderma, mostly affecting the skin so many which involve creams for treatment as listed below.

Plaque morphoea

The most common form, plaque morphoea, does not always need treatment. This form often does not cause symptoms and often gradually improves or clears away after a number of years. However, strong creams or ointments are sometimes used as they may help to stop it spreading.

Creams

  • Cream or ointment containing calcipotriol.
  • Tacrolimus ointment.
  • Imiquimod cream.
  • Steroid creams or ointments.

Other types of localised scleroderma

Treatment will vary depending on the individual situation, the severity of the condition and whether underlying tissues are affected. One of the creams or ointments above may be used in some cases. If it is too widespread or too deep or too severe, one or more of the following treatments may be used:

  • Ultraviolet light therapy.
  • High-dose steroids.
  • Medicines affecting the immune system, such as methotrexate.
  • Physiotherapy or surgery may help if the skin is very tight or if there is a deformity or scar underneath the skin.

What is the outlook (prognosis)?

Plaque morphoea

With this type of localised scleroderma, in many cases the plaques last 3-5 years before softening and fading. The affected areas of skin may gradually go back to normal; however, a brown stain may remain and sometimes a small depressed area of skin. In some cases the plaques remain for many years.

Linear-type localised scleroderma

This tends to persist for longer but may improve after several years. It may come and go and may flare up after a long time of being settled. However, linear-type localised scleroderma, especially the en coup de sabre subtype, may become more extensive with time. This may cause severe contractures (hardening, shortening and tightening of the skin, muscle and/or connective tissue) that result in limited movement and permanent disability of an arm or leg. Damage to underlying brain and eye tissue is a potential, serious complication of the en coup de sabre subtype.

Further reading & references

Morphoea; DermNet NZ

Fett N; Scleroderma: nomenclature, etiology, pathogenesis, prognosis, and treatments: facts and controversies. Clin Dermatol. 2013 Jul-Aug;31(4):432-7. doi: 10.1016/j.clindermatol.2013.01.010.

Careta MF, Romiti R; Localized scleroderma: clinical spectrum and therapeutic update. An Bras Dermatol. 2015 Jan-Feb;90(1):62-73. doi: 10.1590/abd1806-4841.20152890.

Herrick AL, Ennis H, Bhushan M, et al; Incidence of childhood linear scleroderma and systemic sclerosis in the UK and Ireland. Arthritis Care Res (Hoboken). 2010 Feb;62(2):213-8. doi: 10.1002/acr.20070.

Fett NM; Morphea (localized scleroderma). JAMA Dermatol. 2013 Sep;149(9):1124. doi: 10.1001/jamadermatol.2013.5079.

Information reference from Village Practice Thornton, NHS.