What is morphoea?
Morphoea (localised scleroderma) is an inflammation of the skin with a thickening of the skin, usually followed by scarring and pigmentation. It is seen about 3 times more often in women than in men.
What does it look like?
Morphoea is characterised by hard-feeling, often slightly dark-coloured patches in the skin, often with a porcelain-white centre. The disease is present only in the skin — there are no internal abnormalities. It must not be confused with systemic (internal) scleroderma, in which internal organs can be affected. Besides ordinary morphoea, there are two rarer forms: linear morphoea (line-shaped, often on one arm or leg) and “en coup de sabre” morphoea (a rare form usually on the forehead — a linear, deep scar in the skin).
How does it develop?
The cause is unknown. In morphoea there is ultimately a breakdown of the connective tissue, so the skin feels stiff and hard at those sites; hairs and sweat glands also disappear from the skin in the hardening process. One hypothesis is that infection with Borrelia plays a role — the tick introduces Borrelia burgdorferi (also responsible for Lyme disease) into the body — but proof for this tick-bite theory has not yet been provided, although some studies seem to confirm a relationship. Morphoea is also relatively often seen at sites where prolonged pressure is exerted on the skin, such as the edges of (relatively) tight clothing.
What is the treatment?
Many treatments have been described, but none leads to complete cure. Because some researchers think morphoea begins with an infection from a tick bite, an antibiotic course is often given in the early stage. Corticosteroid creams are given as anti-inflammatories, and UVB or PUVA (psoralen tablets plus UVA light therapy) can be tried, as can UVA-1 (narrow-spectrum) light therapy. For chronic “burnt-out” patches, further therapy is not useful.
What is the outlook?
The disease usually remains limited to one or a few patches; rarely are large parts of the skin affected. In the early phase a purple-brown ring usually forms around the hardened skin, and in the burnt-out phase only the hardened skin remains. These patches persist for months to years, but can disappear completely after years — less often in linear scleroderma and almost never in “en coup de sabre” scleroderma.
When to see a doctor
See a doctor if you develop a hard, shiny, discoloured patch of skin, so morphoea can be confirmed and treatment considered in the active phase.