Morphea is a localized form of scleroderma. Scleroderma affects connective tissue and blood vessels. The systemic form can also involve organs, such as the digestive tract and internal organs, as well as the skin. Localized scleroderma is limited to the skin, but can sometimes affect deeper tissues and muscles. With all types of scleroderma, the cause is unclear but is likely related to an autoimmune process.
Morphea causes discolored, usually oval-shaped skin patches that gradually develop a lighter center. The involved skin can become thick, hard and waxy. It may also have less hair and sweat less than other areas. The patches typically develop on the trunk and sometimes on the limbs or face. There are several types of morphea, depending on the spread and deepness of the lesions:
- Circumscribed morphea is morphea localized in 1 to 3 areas. It’s the most common type in adults.
- Generalized morphea affects four or more patches and may also cause fatigue and joint pain.
- Linear morphea involves lesions in a line resembling a scar. It can affect the face, scalp or limbs and often affects underlying muscle and bone. It’s the most common type in children.
- Pansclerotic morphea involves the skin and deeper tissues, including subcutaneous fat, bone, and muscles. It can affect large or small areas and may limit the movement of joints. This is the rarest form of morphea. Other names for it include subcutaneous morphea and morphea profunda.
It is also possible to have a mixed variant morphea with linear and either circumscribed or generalized morphea.
Morphea is not a common disease, but it’s more common in women compared to men. African Americans are also more likely to develop it. It tends to begin when people are in their mid-40s. In children, it most often starts between the ages of 2 and 14 years.
In most cases, morphea resolves on its own over a few years. Doctors may recommend treatment to help manage symptoms, but it won’t shorten the duration of the condition. Morphea treatment may include medicated creams, light therapy, and oral medicines to suppress the immune system.
Morphea is usually not serious. However, the skin damage may cause self-esteem issues. Pansclerotic morphea can cause long-term disability and even death in very rare cases. See your doctor if you notice unusual skin patches.
Morphea symptoms can vary depending on the type, severity and stage of the condition.
Common symptoms of morphea
The most common morphea symptoms include:
- Reddish or purplish discolored skin patches, which may develop a lighter center. Skin patches are generally oval-shaped unless it is linear morphea.
- Hardening or thickening of the skin in the area
- Loss of hair and sweat glands in the area
- Waxy or scar-like appearance with a fading of color to a brownish hyperpigmentation after the inflammation subsides
Lesions usually affect the trunk and limbs with circumscribed and generalized morphea. People with generalized morphea may also have fatigue and joint pain. Linear morphea most often occurs on the head, face, or upper body. People with pansclerotic morphea may have limited range of motion if joints are involved.
See your doctor promptly if you notice new or unusual skin lesions. Managing your symptoms early may help your skin heal with fewer complications. Treatment is most effective when you start it early in the disease.
The exact morphea cause is not known. Experts have several theories, including an autoimmune reaction. Autoimmune diseases happen when the immune system turns on the body’s own tissues for unknown reasons. In morphea, the immune system attacks and damages the skin and sometimes deeper tissues. It’s likely that a combination of genetics and environmental factors interact to cause the disease. Radiation therapy and skin injuries may be triggers for some people.
Morphea tends to develop in children between 2 and 14 years and adults in their mid-40s. A number of other factors increase the risk of developing morphea including:
- African American race
- Family history of autoimmune diseases
- Female sex, with women being three times as likely to develop it than men
Reducing your risk of morphea
Since the cause of morphea is unclear, there is currently no way to prevent it. There are also no known modifiable risk factors. If you are concerned about your risk of morphea, talk with your doctor.
There is no cure for morphea. The disease is self-limiting usually resolves on its own over the course of 3 to 5 years. Small, superficial, localized lesions may not require any treatment. However, doctors have treatment options to help improve your skin and relieve symptoms while you wait for the condition to resolve. Most people respond to morphea treatment, which includes:
- Medicated creams including corticosteroids and a vitamin D cream, such as calcipotriene. This option is best for people with localized morphea.
- Light therapy, or phototherapy, using UV light. Treatments typically involve 2 to 3 sessions per week for 2 to 3 months. People with generalized, linear or mixed morphea may benefit most from light therapy.
- Oral medicines to suppress the immune system, including corticosteroids, methotrexate (Trexall), and hydroxychloroquine (Plaquenil). This option is usually for people with deep tissue involvement, lesions that may result in cosmetic problems, or joint problems or other functional limitations.
Physical therapy can also help people with joint or muscle issues. Morphea treatment is most effective during the first three months of the disease or when inflammation is active.
Your doctor may also recommend a moisturizing cream to reduce symptoms and improve skin health.
After morphea runs its course, the affected skin may have a darkened, waxy or scar-like appearance. Skin color changes can last for years. Starting treatment early in the disease may help limit the cosmetic effects of morphea. Some people will have recurrent lesions at some point during their lifetime.
Morphea can result in restricted joint movement and muscle weakness when it affects deeper tissues. This can cause significant disability in some people. In children, it can interfere with growth and cause discrepancies in limb length.
When morphea affects the face, it can cause atrophy of tissues under the skin, resulting in deformity. It can cause eye problems in children and should be treated with an ophthalmologist on the team.
When morphea affects the scalp, it may cause seizures and other neurological problems. Rarely, complications from morphea can be fatal.