Morphea: Causes, types, and outlook
These patches can occur on the face and neck, hands, feet, back, or chest. Less often, morphea appears on the legs and arms too. Morphea affects less than 3 out of every 100,000 people.
Morphea is usually painless and will disappear on its own, but this may take several years. The condition may return even after it has gone away.
Causes of morphea
Morphea causes patches of skin to become discolored or hardened.
Image credit: Leith C Jones at English Wikipedia, (2008, March 24)
Morphea is considered to be an unusual autoimmune disorder, where the immune system attacks the skin. However, the exact cause of the condition remains unknown.
When morphea occurs, the collagen-producing cells overproduce collagen, causing it to build up and harden.
This could be as a result of:
- repeated occurrences of trauma to the skin
- aggressive treatments, such as radiation therapy
- an infection
- skin damage caused by environmental exposure
Morphea is not a contagious condition and cannot spread from person to person.
The symptoms of morphea differ depending on the stage and severity of the condition.
Common signs and symptoms include:
- patches of reddish or lilac skin, most commonly found on the torso, stomach or back
- linear patches of discolored skin on a person's arms or legs
- patches of skin that gradually turn lighter or have a whitish or yellowish center
- patches of skin that gradually harden and have a thick, shiny appearance
- loss of hair in the affected area
- loss of sweat glands in the affected area
The appearance of morphea usually only affects the skin and its underlying tissue, although it can also affect the bone.
Types of morphea
While some types of morphea are painless, some are more serious, which makes an early diagnosis important.
There are several types of morphea:
Plaque morphea usually consists of a few oval lesions that appear on the skin. The lesions are typically painless but may become itchy. Plaque morphea is the most common type of morphea.
Generalized plaque morphea
Generalized plaque morphea is more widespread than plaque morphea. A person with generalized plaque morphea will have more lesions over a greater area of skin. It can also affect deeper tissues, possibly leading to cosmetic disfigurement and lesions joining together.
This form of morphea is rare and will require aggressive treatment. Pansclerotic morphea occurs when the lesions cover almost all of the body, except the hands and feet. It progresses quickly, and medical intervention is necessary to try to manage it.
Linear morphea is usually found on the arms of legs and appears as a single band of thick, discolored skin. The lesions can extend to the tissue under their skin, as well as the muscles, which can lead to deformities.
Sometimes, linear morphea appears as a line on the forehead, which can cause problems with eyesight and alignment of the teeth. This type of morphea is more likely to affect school-aged children.
If a person becomes aware of skin changes, such as hard, thickening, or reddish patches developing, it is essential to seek medical attention as soon as possible.
A doctor may make a referral to a dermatologist (a doctor who specializes in skin conditions). They may also consult a rheumatologist (a doctor who specializes joints, bones, and muscles) before making a diagnosis.
There is no test for morphea, so a diagnosis will usually be made using a physical examination. A biopsy may also be taken to rule out other conditions.
Risk factors & complications
Morphea is more likely to occur in women than in men. Although it can affect adults and children, morphea is usually diagnosed in children between the ages of 2 and 14, or adults in their mid-40s.
Complications of morphea include:
- restricted joint mobility
- pain in the joints
- cosmetic deformities, which may lead to low self-esteem
- permanent eye damage
- loss of hair in the affected area
- genital lichen sclerosis, which is an associated condition that can cause itching and burning
A vitamin D cream may be recommended to treat morphea. Regularly moisturizing the skin with non-fragranced products may also help.
While there is no cure for morphea, there are various treatments which can help stop it spreading, reduce the appearance of lesions on the skin, and control the symptoms until morphea eventually goes away.
Treatment depends on the severity and type of morphea. Some treatment options include:
- Phototherapy, which is a form of light therapy that uses artificial ultraviolet light.
- Calcipotriene (Dovonex), which is a type of vitamin D cream.
There are several other precautions a person can take to reduce the time it takes morphea to heal. These include:
- applying high factor sunscreen before going outside
- avoiding long, hot showers
- applying moisturizer immediately after bathing
- using only natural, non-fragranced products
- adding moisture to the air at home by using a humidifier during winter
- exercising regularly, which can improve blood circulation
In some cases, doctors may prescribe oral medications, such as methotrexate or high-dose steroids.
When lesions threaten joint mobility or disfigurement, doctors may suggest more aggressive treatment, such as:
- physical therapy
If a child has head or neck morphea, they may need to make regular visits to an eye doctor.
Morphea is a rare skin condition that will usually only affect the appearance of the skin and will go away without treatment.
However, in more severe cases, morphea can cause mobility issues or deformities.
In children, morphea can cause eye damage and problems with limb growth and movement.
Anyone who suspects they may have morphea should seek medical advice to ensure they get appropriate treatment and recommendations on how to manage the condition.