Morphea

Diagnosis

Your doctor may diagnose morphea by examining the affected skin and asking about your signs and symptoms. Your doctor might also take a small sample of your skin (skin biopsy) for examination in a laboratory. This can reveal changes in your skin, such as thickening of a protein (collagen) in the second layer of skin (dermis). Collagen makes up your connective tissues, including your skin. It helps make your skin elastic and resilient.

It's important to distinguish morphea from systemic scleroderma and other conditions. So your doctor might have you undergo a blood test or refer you to a specialist in skin disorders (dermatologist) or diseases of the joints, bones and muscles (rheumatologist).

If your child has head and neck morphea, take him or her for regular comprehensive eye exams, as morphea may cause unnoticeable yet irreversible eye damage.

You might undergo ultrasound and magnetic resonance imaging to monitor disease progression and your response to treatment.

Treatment

Morphea usually lasts several years and then goes away without treatment. It may leave scars or areas of darkened or discolored skin. Until your condition clears up, you may want to pursue treatment that helps control your signs and symptoms.

Treatment options vary depending on the extent of your condition and how it's affecting your life. They include:

• Medicated creams. Your doctor may prescribe a vitamin D cream, such as calcipotriene, to help soften the skin patches. Skin generally begins to improve during the first months of treatment. Possible side effects include burning, stinging and a rash.

  Or your doctor may prescribe a corticosteroid cream to reduce inflammation. When used for a long time, these creams may thin the skin.

• Light therapy. For severe or widespread morphea, treatment may include the use of ultraviolet light (phototherapy).
• Oral medications. For severe or widespread morphea, your doctor may prescribe an immunosuppressive medication, such as oral methotrexate (Trexall), corticosteroid pills or both. Or your doctor may suggest hydroxychloroquine (Plaquenil) or mycophenolate mofetil. Each of these drugs has potential side effects. Talk with your doctor about a drug's risks and benefits before using it.
• Physical therapy. If the condition affects your joints, physical therapy might preserve your range of motion.

Lifestyle and home remedies

Because morphea dries the affected skin, moisturizers may help soften and improve the feel of your skin. It's a good idea to avoid long, hot showers or baths, as these can dry your skin.

Coping and support

Because morphea affects your appearance, it can be an especially difficult condition to live with. You may also be concerned that it will get worse before it goes away.

If you want counseling or support, ask your doctor for a referral to a mental health professional or information about support groups in your area or online.

Preparing for your appointment

You may start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in skin disorders (dermatologist) or a specialist in diseases of the joints, bones and muscles (rheumatologist).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Symptoms you've been having and for how long
• All medications, vitamins and supplements you take, including the doses
• Questions to ask your doctor

For morphea, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes?
• Do I need any tests?
• How long will these skin changes last?
• If the skin discoloration and hardening clears up, will it ever come back?
• What treatments are available, and which do you recommend?
• What side effects can I expect from treatment?
• I have other health conditions. How can I best manage them together?
• What can I do to improve my appearance?
• Do you have any brochures or other printed materials I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you first notice changes in your skin?
• Has this ever happened before?
• Do the changes come and go or are they constant?
• What steps have you taken to treat this condition yourself?
• Have any of those measures helped?
• Have you ever been treated by a doctor for this condition?
• If so, what were the treatments? Did they help?
• Have you had any difficulty chewing food or swallowing?
• Have you experienced extreme cold sensitivity in your fingers or toes?
• Have you noticed any other changes in your general health?