What is Morphea?
Morphea is a form of Scleroderma that literally means “hard skin”. Morphea usually affects only the uppermost layers of your skin, but in some cases may involve fatty or connective tissue below your skin. Morphea is usually chronic or recurrent.
What are the symptoms of Morphea?
- Hardening of the skin
- Thickening of the skin
- Discoloration of the affected skin to look lighter or darker than the surrounding area. Most people develop one or two oval-shaped patches that start out red, purple (lilac-colored) or yellowish and gradually develop a whitish center. Over time, the patches may turn brownish in color and eventually white.
What causes Morphea?
The exact cause of morphea is unknown. It is believed that a reaction of the immune system plays a role in the development of this rare condition. Experts have explored a possible connection between morphea and infection, such as measles or chickenpox, but recent research doesn't support this theory. Other factors that may be associated with the onset of morphea include radiation therapy or repeated trauma to the affected area.
What does Morphea Look Like?
- Ivory-colored plaque with varying degrees of inflammation about its borders
- It generally starts as a reddened area that appears swollen
- The center gradually becomes white or yellow in color
- There can be a lack of hair noted in these lesions
- Sweating may be reduced depending on how advanced the lesion has become
Am I at risk?
Morphea is more common in women than in men. In fact, women are affected about three times as often as men. It is also more common in African Americans. Morphea can occur in any age group, but most patients are between the ages of 20 and 50 years of age at the time of diagnosis. Linear morphea is usually seen at an earlier age with most patients being under 20 years of age and can also affect not just the skin but the underlying structures such as muscle and bone. Because the cause of morphea is unknown, it is difficult to pinpoint those who are more at risk.
When should I seek medical advice?
An early diagnosis allows for the most successful treatment of affected skin, may help slow the development of new patches and allows us to identify and treat complications before they progress.
Testing and diagnosis
Dr. Cleaver may confirm a diagnosis of morphea based on:
- Physical examination. Discoloration combined with skin firmness is a good indicator of morphea. After inspecting your skin and discussing other signs and symptoms you may have, Dr. Cleaver may recommend taking a tissue sample for analysis.
- Tissue sample. Dr. Cleaver may remove a small tissue sample (biopsy) of your affected skin to be examined in the laboratory for abnormalities that allow for diagnosis, such as thickening of the collagen in the second layer of skin (dermis). Collagen is a protein that makes up your connective tissues, including your skin. It helps make your skin elastic and resilient.
Complications associated with Morphea
- The most common complication of morphea is a possible negative effect on your self-esteem and body image if discolored patches of skin appear on your arms, legs and face.
- If your face is involved, your skin may appear depressed and is colored.
- Often only one side of the face is affected, extending from the scalp and forehead to the chin (en coup de sabre).
- Though your skin will likely soften and become less obviously discolored over time, some discoloration may last for years.
- Morphea that affects the arms and legs impairs joint mobility in up to one in five people with the condition.
- The pain may subside in the following months or years, even if discolored patches of skin remain.
- Sometimes new patches of hard, discolored skin making it appear that some patches have joined together.
- This more extensive condition is called generalized morphea.
- Rarely, morphea may be part of a more serious condition called progressive systemic scleroderma, which may affect your blood vessels and internal organs.
Available treatments and drugs
Morphea has no known cure. Treatment of morphea focuses on controlling the signs and symptoms and slowing the spread of the disease. The earlier you begin treatment, the more effective it is. The precise treatment depends on the extent and severity of your condition, but may include:
- Corticosteroids - Dr. Cleaver may prescribe these medications early in the course of treatment, to reduce inflammation and prevent thickening of the collagen. They can be taken either orally or topically or both.
- Anti-malarial drugs - Medications, such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen), may help reduce inflammation and slow the progress of the disease.
- Immunosuppressive medications - Dr. Cleaver may prescribe these drugs to control your immune system and reduce inflammation.
- Physical therapy - This type of treatment uses stretching, strengthening and range-of-motion exercises to improve the mobility of your joints.
- Laser treatments, topical creams and chemical peels - These approaches help bring the look of natural color back to affected skin after the inflammation has subsided.
- Plastic surgery - Cosmetic surgery techniques may improve the look of discolored skin in highly visible places.
Are there any home remedies or lifestyle adaptations I can use?
The sun can darken skin already discolored by morphea, so be sure you wear sunscreen. Cover affected skin and avoid direct contact with the sun whenever possible. Use moisturizers to soften and improve the feel of your skin. If you have morphea in more visible locations, makeup and other topical treatments may help to hide the condition and make your skin appear more natural.