Morphea Medication

Updated: May 21, 2018
  • Author: Jennifer V Nguyen, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

In general, therapy aimed at reducing inflammatory activity in early disease is more successful than attempts to decrease sclerosis in well-established lesions. The approach to treatment of the various subtypes of morphea is described in Medical Care. Note that phototherapy represents another important modality.

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Corticosteroids

Class Summary

These agents reduce inflammation and suppress collagen synthesis.

Triamcinolone topical (Kenalog Orabase, Kenalog topical, Pediaderm TA)

Triamcinolone is a medium-potency corticosteroid that reduces inflammation and may prevent progression of sclerosis.

Clobetasol propionate 0.05% cream or ointment (Temovate)

Clobetasol propionate is a superpotent topical corticosteroid that reduces inflammation and may prevent progression of sclerosis.

Prednisone (Deltasone, Orasone)

Prednisone reduces inflammation and prevents the progression of sclerosis. Systemic corticosteroid therapy (often used in combination with MTX; see below) is appropriate for patients with active inflammatory disease that is widespread, severe, and/or potentially disfiguring/disabling.

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Vitamin D analogs

Class Summary

These agents inhibit fibroblast activity and TGF-beta production and have anti-inflammatory effects.

Calcipotriene 0.005% ointment (Dovonex)

Calcipotriene is a synthetic vitamin D-3 analog that can lead to softening of morphea lesions.

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Antirheumatic agents

Class Summary

These agents can reduce inflammation associated with morphea.

Methotrexate (Rheumatrex, Trexall)

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA and RNA synthesis in lymphocytes and other immune cells. This and other mechanisms lead to an anti-inflammatory effect, which is reflected in reduced levels of circulating cytokines such as IL-2, IL-6, and IL-8 (indicators of disease activity) in morphea patients. Response is often delayed until 1-3 months after initiation of therapy.

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Immunosuppressant Agent

Tacrolimus ointment (Protopic)

The mechanism of action of tacrolimus is not known. It reduces itching and inflammation by suppressing the release of cytokines from T cells. It also inhibits transcription for genes that encode IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in the early stages of T-cell activation. Additionally, it may inhibit release of preformed mediators from skin mast cells and basophils and down-regulate the expression of FCeRI on Langerhans cells. It can be used in patients as young as 2 years. Drugs of this class are more expensive than topical corticosteroids. It is available as an ointment in concentrations of 0.03 and 0.1%. It is indicated only after other treatment options have failed.

Mycophenolate

Mycophenolate inhibits inosine monophosphate dehydrogenase (IMPDH) and suppresses denovo purine synthesis by lymphocytes, thereby inhibiting their proliferation. It inhibits antibody production.

Two formulations are available and are not interchangeable. The original formulation, mycophenolate mofetil (MMF, Cellcept) is a prodrug that once hydrolyzed in vivo, releases the active moiety mycophenolic acid. A newer formulation, mycophenolic acid (MPA, Myfortic) is an enteric-coated product that delivers the active moiety.

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