A systematic review of morphea treatments and therapeutic algorithm - 14/10/11
Abstract |
Background |
Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care.
Objective |
We sought to create an evidence-based therapeutic algorithm.
Methods |
We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized.
Results |
Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported.
Limitations |
Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures.
Conclusion |
Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making.
Le texte complet de cet article est disponible en PDF.Key words : localized scleroderma, therapeutics
Abbreviations used : BB, ECDS, IV, IVMP, MSS, MTX, NB, PCMT, PUVA, RCT, SCSS, SQ, US, UV
Plan
Dr Jacobe’s work is supported by National Institutes of Health 5 K23 AR056303-02 and Career Real Estate Women Research Award. She has also received funding from the Dermatology Foundation in the form of a Career Development Award and Medical Dermatology Research Award. |
|
Conflicts of interest: None declared. |
Vol 65 - N° 5
P. 925-941 - novembre 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?