Scleroderma - Morphea

Morphea is the name given to localised patches of hardened skin that are smooth and shiny. Usually they appear on the trunk, but they can affect any part of the body. They are painless and there are normally no other problems or symptoms.

Morphea usually subsides on its own over time, though recurrences are common. In the meantime, medications and therapies are available to help treat the skin dis-coloration and other effects.

The skin may or may not be softer than when the plaque was “new". The plaques may lose their hairs and sweat glands and the skin can look and feel dry. Sometimes morphea can occur in a line and usually a!ects a limb in a unilateral fashion. This is known as linear morphea. When a whole limb is a!ected, structures deep to them (fat, muscle and even bone) may be at risk of growing poorly. If the linear morphea crosses a joint, contractures can form that limit the movement of joints.

In one type of linear morphea, a narrow groove runs up one side of the forehead into the scalp. This type of linear morphea is known as “en coup de sabre". If the morphea blisters, as is possible but uncommon, the a!ected skin can break down and ulcers may form. These ulcers often heal poorly and are susceptible to becoming infected.

Rarely, morphea plaques can cover much of the skin surface area (generalised morphea). When this happens over the trunk, it can cause restriction of skin movement and difficulty with expansion of the chest when breathing.

Morphea usually appears between the ages of 20 and 50 years, more often in females, and is most commonly seen in the linear form in children. Morphea can appear for the first time during pregnancy. It is rarely seen in people with dark skin and does not usually run in families.

In plaque morphea, the most common form, slightly raised, oval or round areas of thickened, waxy looking skin develop slowly and spread outwards. There are usually no symptoms associated with the development of these plaques although sometimes there is an itchy sensation to them. The middle of the plaques are white or ivory in colour but the edges in new plaques often have a reddish or purplish appearance to them. Older plaques of morphea tend to look like brown bruises and no longer have a clearly defined edge.

Symptoms

Signs and symptoms of morphea vary, depending on the type and stage of the condition. They include:

  • Reddish or purplish oval patches of skin, often on the abdomen, chest or back
  • Patches that gradually develop a lighter or whitish center
  • Linear patches, especially when on the arms or legs
  • A gradual change in the affected skin, which becomes hard, thickened, dry and shiny
  • Loss of hair and sweat glands in the affected area over time

Morphea usually affects only the skin and underlying tissue and, rarely, bone. The condition generally lasts several years and then disappears on its own. But it usually leaves some patches of darkened or discolored skin.

When to see a doctor

If you notice reddish patches of hardening or thickening skin, see your doctor. Early diagnosis and treatment may help slow the development of new patches and allow your doctor to identify and treat complications before they worsen.

Causes

The causes of morphea are unknown. It may be due in part to an unusual reaction of the immune system. Or it may be triggered by:

  • Radiation therapy
  • Repeated trauma to the affected area
  • A recent infection, such as measles or chickenpox

The condition isn't contagious.

Certain factors may affect your risk of developing morphea, including:

Your 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. As well as your race. Morphea is more prevalent among Caucasians.

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 your 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.

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