#4-05E. Unveiling Morphea: Practical Approaches to Localized Scleroderma (Best Pract Res Clin Rheumatol, 2026)

Have you ever struggled with evaluating the depth of tissue involvement or determining the optimal timing to initiate systemic therapy in patients presenting with localized skin sclerosis? Morphea, or localized cutaneous scleroderma, encompasses a heterogeneous spectrum of fibrosing skin disorders where delayed diagnosis frequently occurs due to an insidious onset and the lack of validated biomarkers. This comprehensive review updates the epidemiology, clinical presentations, and management of morphea across both pediatric and adult populations. A critical clinical takeaway is the urgent need for prompt diagnosis and early initiation of systemic therapies—such as methotrexate combined with corticosteroids—especially in deep, linear, or pediatric cases to prevent irreversible orthopedic and functional damage. However, when critically appraising this evidence, it is important to note that current treatment guidelines still heavily rely on expert opinion and retrospective cohorts, underscoring a significant lack of high-quality, prospective randomized controlled trials. For practicing physicians, this article is highly valuable as it provides actionable, step-wise therapeutic algorithms to accurately assess disease activity and effectively transition from topical to systemic treatments, directly minimizing long-term morbidity in daily clinical practice.

Citation: Matucci-Cerinic C., Lipsker D., Malattia C., Martini G. A practical clinical approach to the diagnosis and management of morphea (localized scleroderma). Best Practice & Research Clinical Rheumatology. 2026. DOI: 10.1016/j.berh.2026.102127

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.