Interventions for morphea.

Area of Science:

• Dermatology
• Rheumatology
• Immunology

Background:

• Morphea is an immune-mediated disease causing hardened skin areas due to excess collagen.
• Optimal interventions for morphea lack consensus due to diverse clinical features and stages.
• This review assesses current treatment effects for all forms of morphea.

Purpose of the Study:

• To evaluate the efficacy and safety of various treatments for morphea.
• To synthesize evidence from randomized controlled trials (RCTs) on morphea interventions.

Main Methods:

• Searched multiple databases (Cochrane, MEDLINE, Embase, etc.) and trial registers up to July 2018.
• Included 14 RCTs with 429 participants (ages 3-76) diagnosed with any morphea subtype.
• Assessed primary outcomes: global disease improvement and adverse effects, using GRADE for evidence quality.

Main Results:

• Oral methotrexate plus prednisone may improve juvenile active morphea compared to placebo, with a slightly higher risk of adverse events.
• Phototherapy (medium-dose UVA-1, low-dose UVA-1, narrowband UVB) showed little to no difference in global morphea improvement.
• UVA-1 phototherapy might cause more mild tanning than narrowband UVB; evidence quality for all findings is low.

Conclusions:

• Combination therapy of oral methotrexate and prednisone may benefit juvenile morphea, but requires careful monitoring for side effects.
• Phototherapy options (UVA-1, narrowband UVB) appear comparable for morphea treatment, with potential differences in tanning.
• Low-quality evidence necessitates larger, multicenter RCTs to validate findings and explore subtype-specific responses.