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 orrecurrent.

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.

Am I at risk?

• Morphea is more common in women then in men.  In fact women are affected about
  three times as often as men. 
• It is also more common in Africa Americans
• Morphea occurs 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?

If you notice patches of discoloring, hardening or thickening skin see your doctor. 
An early diagnosis allows for the most successful treatment of affected skin, may help
slow the development of new patches, and allows your doctor 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

o       If your face is involved, your skin may appear depressed and is colored.

o       Often only one side of the face is affected, extending from the scalp and
forehead to the chin (en coup de sabre)

o       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 appear in such numbers
that some may seem to join 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 appearmore natural.

What does Morphea Look Like?

• The appearance of morphea is that of a well defined:
• Ivory-colored plaque with varying degrees of inflammation about its boarders
• 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 and sweating may be
  reduced depending on how advanced the lesion has become

Information gathered from http://www.mayoclinic.com/health/morphea/DS00