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Diseases and Conditions
Morphea
From MayoClinic.com
Special to CNN.com

Introduction

Morphea is a rare skin condition that causes red or purple patches on your skin. The condition typically appears on your torso, arms and legs. Morphea occurs in all age groups, but generally affects women more than men.

Morphea is a localized form of scleroderma, a condition that can cause a wide variety of problems, from skin discoloration to internal organ damage. Morphea tends to affect only the outermost layers of your skin, with no damage to internal organs. Sometimes, morphea can restrict movement in your joints.

Treatment depends on the severity of morphea. Your doctor may recommend medications, physical therapy or other treatments.

Signs and symptoms

Morphea is a form of scleroderma, a term that literally means "hard skin." In addition to hardening your skin, morphea thickens and discolors the affected skin to look lighter or darker than the surrounding area.

Most people develop one or two oval-shaped patches that start out red, purple or yellow and gradually develop a whitish center.

Morphea usually affects only the uppermost layers of your skin, but in some cases may involve fatty or connective tissue below your skin.

Causes

The exact cause of morphea is unknown. It's usually chronic or recurrent, but it's not hereditary. It's believed that a reaction of the immune system plays a role in the development of the condition.

Experts once thought morphea was associated with infection, such as measles or chickenpox, but recent research doesn't support this theory. Connection with the organism that causes Lyme disease also has been suggested, but unproved.

Risk factors

Morphea is more common in women than in men, and it occurs in all age groups. It's neither infectious nor cancerous. Because the cause is unknown, it's difficult to pinpoint those people who may be at highest risk.

When to seek medical advice

If you notice patches of discoloring, hardening or thickening skin, see your doctor. An early diagnosis allows for the most successful treatment of affected skin, may help slow the development of new patches and allows your doctor to identify and treat complications before they progress.

Screening and diagnosis

A doctor who specializes in skin conditions (dermatologist) may confirm a diagnosis based on:

  • Physical examination. Discoloration and hardness of your skin are good indicators of morphea. After inspecting your skin and discussing other signs and symptoms you may have, your doctor may recommend taking a tissue sample for analysis.
  • Tissue sample. Your doctor may remove a small tissue sample (biopsy) of your affected skin to be examined in the laboratory for abnormalities that allow for diagnosis, such as thickening of the collagen in the second layer of skin (dermis). Collagen is a protein that makes up your connective tissues, including your skin. It helps make your skin elastic and resilient.

Complications

The most common complication of morphea is a possible negative effect on your self-esteem and body image if discolored patches of skin appear on your arms, legs and face.

If your face is involved, your skin may appear depressed and discolored. Though your skin will likely soften and become less obviously discolored over time, some discoloration may last for years.

Morphea that affects the arms and legs impairs joint mobility in up to one in five people with the condition. The pain may subside in the following months or years, even if discolored patches of skin remain.

Sometimes new patches of hard, discolored skin appear in such numbers that some may seem to join together. This more extensive condition is called generalized morphea. Rarely, it may become part of a more serious condition called progressive systemic scleroderma, which may affect your blood vessels and internal organs.

Treatment

Morphea has no known cure. Treatment focuses on controlling the signs and symptoms and slowing the spread of the disease. The earlier you begin treatment, the more effective it is. The precise treatment depends on the extent and severity of your condition, but may include:

  • Corticosteroid medications, which your doctor may prescribe early in the course of treatment, to reduce inflammation and prevent thickening of the collagen
  • Antimalarial medications, such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen), to reduce inflammation and slow the progress of the disease
  • Immunosuppressive medications to control your immune system and reduce inflammation
  • Physical therapy to improve the mobility of your joints
  • Laser treatments, topical creams and chemical peels to bring the look of natural color back to affected skin after the inflammation has subsided
  • Plastic surgery to improve the look of discolored skin in highly visible places

Self-care

The sun can darken skin already discolored by morphea, so be sure you wear sunscreen, cover affected skin and avoid direct contact with the sun whenever possible. In addition, use moisturizers to soften and improve the feel of your skin.

If you have morphea in more visible locations, makeup and other topical treatments may help to hide the condition and make your skin appear more natural.

May 05, 2006

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