Morphea

Morphea (mor-FEE-uh) is a rare condition that causes painless, discolored patches on your skin.

Typically, the skin changes appear on the belly, chest or back. But they might also appear on your face, arms and legs. Over time the patches may become firm, dry and smooth. Morphea tends to affect only the outer layers of your skin. But some forms of the condition also affect deeper tissues and may restrict movement in the joints.

Morphea usually improves on its own over time, though recurrences are common. In the meantime, medications and therapies are available to help treat the skin discoloration and other effects.

Signs and symptoms of morphea vary depending on the type and stage of the condition. They include:

• Reddish or purplish oval patches of skin, often on the belly, chest or back
• Patches that gradually develop a lighter or whitish center
• Linear patches, especially on the arms or legs and possibly the forehead or scalp
• A gradual change in the affected skin, which becomes firm, thickened, dry and shiny

Morphea affects the skin and underlying tissue and sometimes bone. The condition generally lasts several years and then improves or at times disappears by itself. It may leave scars or areas of darkened or discolored skin. It is possible for morphea to recur.

When to see a doctor

See your doctor if you notice reddish patches of hardening or thickening skin. Early diagnosis and treatment may help slow the development of new patches and allow your doctor to identify and treat complications before they worsen.

The cause of morphea is unknown. It may be caused by an unusual reaction of your immune system. In people at increased risk of morphea, it could be triggered by injury to the affected area, medications, chemical toxins, an infection or radiation therapy.

The condition isn't contagious.

Certain factors may affect your risk of developing morphea, including:

• Being white and female. Morphea is most common in white females.
• Age. The condition can affect people at any age. It usually appears between the ages of 2 and 14 or in the mid-40s.
• A family history of morphea. This condition can run in families. People with morphea are more likely to have a family history of morphea and other autoimmune diseases.

Morphea can cause a number of complications, including:

• Self-esteem issues. Morphea can have a negative effect on your self-esteem and body image, particularly if discolored patches of skin appear on your arms, legs or face.
• Movement problems. Morphea that affects the arms or legs can impair joint mobility.
• Widespread areas of hardened, discolored skin. Numerous new patches of hardened, discolored skin may seem to join together, a condition known as generalized morphea.
• Loss of hair and sweat glands. Over time, you may lose hair and sweat glands in the affected area.
• Eye damage. Children with head and neck morphea may experience unnoticeable but permanent eye damage.

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.

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.

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.

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.

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?