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.
Approximately 300,000 people in the United States have scleroderma. Women are affected three times as often as men. Although the disease can develop at any age, it most frequently begins past middle age. It is most frequently a chronic and often progressive illness.
Morphea is usually a benign skin condition of one or two colored skin plaques which affect only the skin and that gradually fade in three to five years, even without any treatment. It normally occurs by itself and not in conjunction with any other symptoms or illnesses, and generally speaking, the cause of most cases of morphea is still unknown.
Morphea makes patches called “plaques” or “lesions” appear on the skin. It usually begins with a whitish patch with a purple border. It often has the appearance of a bruise. However, it can look very different from patient to patient. It is more common in children and adolescents than it is in adults. When morphea affects the face, other tissues may be affected.
Types –
There are several types of morphea and each type looks a little different –
- Plaque morphea is usually an oval shape with a yellow or ivory colour in the centre and purple at the edges. It may feel thick, firm, and waxy, and may look shiny.
- Generalized morphea begins as many plaques on the body that may get bigger or join together.
- Linear morphea appears in a line. It is usually on the arm or leg, and may also occur on the face.
As morphea progresses, the affected skin may change. The veins under the skin may show more clearly. The affected skin may look thinner, and may look raised or sunken compared to the skin around it.
Causes
The cause of morphea is unknown at this time. We know that patients with family histories of autoimmune diseases are more likely to get morphea, so there is probably a genetic link. Morphea has been reported to occur after injuries and radiation therapy, which may play a role as a disease trigger.
It appears to start off with damage to small blood vessels and the release of cytokines (chemical messenger proteins) that promote fibrosis (scarring).
Morphoea can sometimes follow –
- Localised injury, including injections and radiotherapy
- Tick bites – it has been associated with Lyme disease due to Borrelia burgdorferi infection
- Pregnancy
- Measles and other viral infections
- Autoimmune diseases including vitiligo, diabetes, thyroid disease, lichen sclerosus and lichen planus
- Medications including bleomycin and penicillamine.
Risk Factors
Certain factors may affect the risk of developing morphea, including –
- Sex and Age – Females are more likely to develop morphea than are males. The condition can affect people at any age. It usually appears between the ages of 2 and 14 or in the mid-40s.
- Race – Morphea is more prevalent among Caucasians.
Symptoms
Some children and adults with morphoea complain of muscle and joint pains as well as fatigue. Seizures, headaches, vascular malformation, ocular defects and other neurological symptoms may be associated with morphoea, especially in those with en coup de sabre or progressive facial hemiatrophy.
- 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.
The Morphea looks 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
Complications
Morphea can cause a number of complications, including –
Self-esteem issues – Morphea can have a negative effect on your self-esteem and body image, particularly if discolored patches of skin appear on the arms, legs or face.
Movement problems – Morphea that affects the arms or legs can impair joint mobility.
Widespread areas of hardened, discolored skin – Numerous new patches of hard, discolored skin may seem to join together, a condition known as generalized morphea.
Eye damage – Children with head and neck morphea may experience unnoticeable, permanent eye damage.
Treatment
The best treatment for morphoea is uncertain and current treatments often fail to help
Benefit has been reported in some cases from the following treatments –
- Topical calcipotriol
- Topical tacrolimus
- Potent topical steroids
- Imiquimod cream
- Photochemotherapy or phototherapy with NBUVB or UVA1
- Methotrexate
- Systemic steroids
- Mycophenolate
- Pentoxifylline
- Penicillamine
- Diphenylhydantoin (phenytoin)
- Physiotherapy is often recommended to prevent joint contractures when morphoea affects the limbs.
- Light therapy – A special treatment that uses ultraviolet light (phototherapy) may improve your skin’s appearance, especially when used soon after skin changes appear.
Alternative Treatment
Omega 3 Fatty Acids – Omega-3 fatty acids help improve blood flow, and a few studies suggest they may reduce symptoms of Morphea.
Bromelain – Although it is not a specific treatment for scleroderma, bromelain helps reduce pain and inflammation.
Probiotic supplement – These “friendly” bacteria help maintain gastrointestinal health. One study found that probiotics helped reduce bloating in people with scleroderma that affected their digestive systems.
Vitamin D insufficiency and deficiency rates were very high among people with the disorder. The study’s authors note that common vitamin D supplementation does not appear to correct the deficiency in scleroderma patients, and that a higher dose is most likely needed for such individuals.
Turmeric – Turmeric reduces inflammation. It may also help relieve pain, although more studies are needed to tell whether it works for scleroderma. It is often combined with bromelain.
Gotu kola for blood vessel health and circulation. Some purified extracts of gotu kola seem to reduce symptoms of scleroderma. More research is needed.
Acupuncture– A few studies suggest that acupuncture may improve blood flow in the hands and fingers, help heal fingertip ulcers, and may reduce the formation of fibrous tissue. It may also relieve pain.
Massage and Physical Therapy – Research suggests that massage may help improve circulation. More research is needed to know whether massage works for scleroderma.
Mind-Body Medicine – Biofeedback may help some people with scleroderma better control the temperature in their hands and feet, although studies are mixed. Other mind-body techniques such as counseling, meditation, and emotional freedom technique (EFT) may also help.
Reference –
http://www.dermnet.com/images/Morphea
http://www.healthcentral.com/encyclopedia/hc/morphea-scleroderma-3168904/
http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/47360
http://www.healthhype.com/morphea-hardened-skin-patches.html
http://patient.info/doctor/morphoea
http://www.mayoclinic.org/diseases-conditions/morphea/basics/definition/con-20028397