Multi-System Approaches for Treating Pediatric Morphea

In recognition of National Scleroderma Awareness Month, HCPLive spoke with several prominent dermatologists today who addressed some of the concerns and advancements related to the rare, multi-system disease.

Scleroderma is often referred to as “morphea” by dermatologists, and the condition typically presents with the tightening and hardening of the skin. Depending on the region of the body, it can result in everything from swollen joints to lesions on the face, arms, and midsection.

For this episode of DocTalk, Karan Lal, DO, MS, FAAD, Schweiger Dermatology Group and member of The Society for Pediatric Dermatology , returned to the program to speak on the different variations of morphea in pediatric patients, and the communal approach that is required to treate the disease among dermatologists and other branches of medicine.

“The most common type of morphea in pediatric patients is localized morphia, and a majority of patients have what is called en coup de sabre or linear morphia, where the skin on the forehead gets so thick that it actually divots in and you can have involvement of your dura mater, your muscle and even bone,” Lal said. “The reason that's considered very high risk is because it can be associated with issues with the eye, visual disturbances, headaches, seizures, and a lot of stuff in the brain. So, it's it actually truly ends up being a multi system disease.”

When examining for morphea, Lal will consider a number a laboratory marker when ordering MRIs of the head and brain of affected patients. Patients will also be sent to an optometrist if there are any concerns regarding involvement in the eyes.

Given the seriousness of the disease, which included the psychosocial implications of it, dermatologists such as Lal will try to treat morphea with systemic therapies and, intermittently, with long-term medications such as methotrexate.

Even so, morphea can be difficult to full manage as solely a dermatologic issue; as Lal noted earlier, it is a multi-system disease that requires aid from different branches of medicine.

“It's not what we used to say it as just being a skin only disease...(localized scleroderma) we know now is more of a systemic inflammatory disease, and it requires multidisciplinary care,” Lal said. “It's not common, but I see it pretty frequently. But I have a bias as a pediatric dermatologist, and it's actually even harder to find a pediatric rheumatologist. There's such a need. So if anything, please push your colleagues to go into pediatric rheumatology because we need more of them.”

To hear more from Dr. Lal on signs of impending morphea, listen to the full episode of DocTalk above.