Phosphodiesterase-4 inhibition in localized scleroderma: A case series of topical roflumilast

Localized scleroderma, or morphea, is a chronic fibrosing skin condition with limited therapeutic options, particularly for patients who are elderly, immunocompromized, or intolerant to systemic immunosuppressants. We present three adult patients with severe, treatment-refractory localized scleroderma who demonstrated rapid and substantial clinical improvement following initiation of topical roflumilast 0.3% cream under occlusion. All patients had failed or declined systemic therapy. Within 6-12 weeks, each showed marked reductions in inflammatory activity, pain, and skin induration, as measured by validated clinical scores (Localized Scleroderma Activity Index, Physician's Global Assessment of Activity/Damage). No adverse events were reported. Roflumilast, a potent phosphodiesterase-4 inhibitor with anti-inflammatory and antifibrotic properties, may offer a well-tolerated, nonimmunosuppressive treatment option in morphea. This is the first reported case series using topical roflumilast in localized scleroderma and supports further investigation of phosphodiesterase-4 inhibition as a therapeutic strategy in fibrosing skin disease.