How Morphea Differs from Other Types of Scleroderma

I had almost forgotten about the brown patch of skin the size of a strip of bacon until I happened to glance in a mirror. It reminded me that if I had to have one of the types of scleroderma, I was glad it was morphea.

What is Scleroderma?

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) describes scleroderma as a collection of disorders affecting the body's connective tissue--tissue that supports the skin and internal organs. This disorder causes this issue to harden or thicken. Many patients experience discomfort in their muscles and joints.

Scleroderma is often hard to diagnose. While doctors treat initial skin problems, the condition can also affect internal organs. There is no cure. Anyone can get this disorder, though it's far more common in women than in men.

Doctors divide scleroderma into two general types: systemic and localized. Within these categories are subtypes. Patients with a systemic disorder face treatment for a potential host of complications affecting the skin, kidneys, heart, digestive tract and lungs. Some develop problems with their teeth, speech and movement. Health care professionals concentrate on reducing symptoms and damage to their patients' bodies.

How Morphea Differs

Morphea is a localized form of scleroderma. According to the Mayo Clinic, it tends to affect only the outermost layers of the skin, including the collagen or second layer, unlike systemic scleroderma. The skin hardens and thickens, and the area usually becomes discolored, starting with two oval patches that turn from red to purple, sometimes with a white center. Eventually, these patches can turn a brown or off-white color.

Unlike the other type of scleroderma, morphea sometimes lasts a few years and then vanishes.

In contrast to the many potential complications of systemic scleroderma, those associated with morphea in most cases have to do with cosmetic issues. A minority of affected individuals experience problems with joint mobility.

Patients with systemic disease need to be treated for each individual complication of the disorder, sometimes requiring the services of a number of specialists like rheumatologists, dermatologists, cardiologists, gastroenterologists and urologists. Many doctors suggest no treatment whatsoever for morphea, however, because the disease sometimes disappears on its own and because treatment means possible side effects.

For cases where the disease is widespread or has facial involvement, they might suggest a number of treatments. Among the drugs that have proven helpful are calcipotriene cream (brand name: Dovonex), which is a synthetic form of vitamin D. Some patients take corticosteroids, antimalarial drugs (Plaquenil) or immunosuppressants (methotrexate, cyclosporine).

In addition, doctors advise morphea patients to steer clear of long, hot showers or baths since they can be especially drying to the skin. Makeup and certain other topical additives can help conceal affected areas.

My Experience

I found out that I had morphea in my early 20s. I awoke one cold Wisconsin morning to find three white, shiny patches on my left breast. I had been quite sick for months and did not learn until years later that I had been suffering since childhood with Crohn's disease, a chronic digestive ailment usually linked to a faulty immune system.

Because I had been ill, I already had a cadre of doctors trying to figure out why. My internist took one look and sent me to a dermatologist the same day. This specialist took biopsies but assured me that I had not contracted an overnight case of breast cancer.

He also noted the large "bacon" area on the left side of my waist. It was and remains brown. I told him that I had been a very overweight child, and my mother had insisted the discoloration was caused by tight clothing that rubbed against my skin.

Both areas turned out to be morphea. The doctor immediately explained that morphea differed significantly from other variations of scleroderma, which I would never develop. The white spots vanished after using a topical cream for a few days. The brown area represented burnt-out disease. Since being diagnosed with Crohn's at 31, I have been on either corticosteroids or immunosuppressants continuously. I have never had another outbreak of morphea.

Sources:

http://www.niams.nih.gov/Health_Info/Scleroderma/scleroderma_ff.asp#b

http://www.mayoclinic.com/health/morphea/DS00718