Morphea means an unknown
disease of the dermis,
affects both children,
Just a couple of points here
so that you know that
you’ve heard of morphea
at some point in time in
your medical education.
Dermis is your pathology.
Classic shiny and
The clinical pearl here, shiny, classic.
Often with iliac-colored
erythema of the periphery.
Over time, it becomes burnt out.
thickened and bound,
and involvement across joints
may yield contractures.
Morphea, involvement of the
dermis, extremely shiny.
If you know that, you'll be in good shape.
It could affect both men and
women with equal preponderance.
Morphea can occur in linear
line on the forehead.
And this is then referred to
as being “cut of the sword.”
If you take a look at the
breast of this individual,
take a moment here to
make sure that you
are identifying where we are on the body.
Here, we have a female,
and you’ll notice on the left that it's
the breast that’s being involved.
As you move from
your left to right,
and I want you to focus on
the right most picture here,
look how shiny this is.
Literally, you look at the
skin and it’s glistening.
You have the light, which is then
reflecting off this shiny skin.
In morphea, my disease is where?
It is in your dermis.
And because of the involvement of
your dermis at some point in time,
when it gets burned out,
then you end up having perhaps any
part of that area which is then going --
I want you to compare the
picture on the left,
and I want you to see as to how it’s
contracted as you move to the right.
Is that clear?
It’s almost like there is fibrosis taking
place in which it’s causing contraction.
It almost looks like
What is my
Well, we’ll take a look at a few.
Square biopsy edges,
a thickened scar-like dermis.
Think about the picture that I just
showed you on gross examination,
where in which that
skin looked very shiny.
And you have entrapment of sweat
glands and other appendages
by thick collagen bundles.
If you then take a look at
the picture on the right,
you’ll notice that there’s
abundance of collagen
which is then causing a
And with this then happening, and you can
imagine wherever this is taking place,
for example, from the breast
in the previous picture,
then you’ll have the
contraction taking place.
For limited lesions, first-line therapies
include topical corticosteroids.
For deep and more widespread lesions,
the first-line therapy is to treat
the lesions with systemic weekly
methotrexate, followed by prednisolone.
Second-line therapy for resistant cases
is oral hydroxychloroquine. Vitamin D derivatives
are second-line treatments because their efficacy
is supported by open-label clinical trials,
not by RCTs.