A systematic review of morphea treatments and therapeutic algorithm

作者：Zwischenberger Brittany A; Jacobe Heidi T^*

来源：Journal of the American Academy of Dermatology, 2011, 65(5): 925-941.

DOI：10.1016/j.jaad.2010.09.006

• localized scleroderma
• therapeutics

Background: Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care.
Objective: We sought to create an evidence-based therapeutic algorithm.
Methods: We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea.
Results were summarized. Results: Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported.
Limitations: Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures.
Conclusion: Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making. (J Am Acad Dermatol 2011;65:925-41.)

• 出版日期2011-11